Columbia  Stotoettfitp 

mtljeCttpoOfottigork 

College  of  iPftpgictattg  ano  burgeons 
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PROPERTY  OF 
FREDERICK  B.  RLIM 

1 


LEAD    POISONING 


LEAD 


ISONING 


FROM     THE^tD^DUSTgJAL, 
MEDICAL,    AND    ^dciAL 
POINTS  OF  VIE 


LECTURES 


DELIVERED    AT 

THE  ROYAL  INSTITUTE  OF   PUBLIC  HEALTH 

BY 

SIR   THOMAS    OLIVER 

M.A.,  M.D.,  M.R.C.P. 

CONSULTING    PHYSICIAN,    ROYAL   VICTORIA   INFIRMARY,    AND.  PROFESSOR    OF 

THE    PRINCIPLES  AND   PRACTICE  OF   MEDICINE,  UNIVERSITY  OF   DURHAM 

COLLEGE   OF   MEDICINE,    NEWCASTLE-UPON  TYNE  ;    LATE   MEDICAL 

EXPERT,    DANGEROUS    TRADES    COMMITTEE,    HOME    OFFICE 


PAUL  B.  HOEBER 

67    &    69    EAST    59TH    STREET 

NEW  YORK 

1914 


hx 


ol4 


[Printed  in  England.] 


E.  O.  O. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/leadpoisoningfroOOoliv 


PREFACE 

The  growing  interest  taken  in  the  subject  of  lead 
poisoning  is  my  excuse  for  the  publication  in  book 
form  of  the  lectures  delivered  in  the  Royal  Insti- 
tute of  Public  Health,  Russell  Square.  No  metal 
is  more  widely  used  in  the  arts  and  manufactures, 
and  none  lends  itself  to  the  increasing  require- 
ments of  modern  life  and  industrial  development 
more  than  lead.  In  the  following  pages  I  have 
tried  to  place  before  all  who  may  read  these 
lectures  the  channels  by  which  lead  gains  en- 
trance into  the  body,  the  effects  of  the  metal  upon 
the  organism,  and  how  these  effects  may  be  got 
rid  of.  Although  trades  in  which  lead  or  its 
compounds  are  used  will  always  be  more  or  less 
dangerous,  the  extent  to  which  industrial  lead 
poisoning  has  been  reduced  is  an  excellent  illus- 
tration of  what  legislation  has  accomplished,  and 
of  the  good  effected  by  Home  Office  inspection 
and  regulations.  What  has  been  accomplished 
in  this  respect  is  but  earnest  of  what  can  be.     In 


viii  PREFA  CE 

the  hope  that  by  throwing  additional  light  upon 
the  subject  such  an  object  may  be  attained,  this 
little  book  is  launched  upon  the  medical  profession 
and  the  public. 

In  the  Appendix  are  printed,  by  permission  of 
the  Controller  of  H.M.  Stationery  Office,  the 
Factory  and  Workshop  Orders  relating  to  lead 
poisoning. 


THOMAS  OLIVER. 


7,  Ellison  Place, 

Newcastle-upon-Tyne, 
August,  1914. 


CONTENTS 


PAGE 


Lead  Smelting            .....  5 

Manufacture  of  Red  Lead            -           -  18 
Manufacture  of  White  Lead,  or   Lead   Car- 
bonate      -           -           -           -           -  22 

Statistics  of  Industrial  Lead  Poisoning          -  34 

Lead  Paints  and  Leadless  Paints            -           -  55 

Lead  Poisoning  among  Painters  -           -  65 

Manufacture  of  China  and  Earthenware       -  68 

Manufacture  of  Pottery  as  a  Home  Industry  76 

Electrical  Accumulator  Works             -           -  82 

Printing  and  Type  Founding       -           -  83 
Plumbing,  Dyeing,   Glass-Making,  Tinning  of 

Hollow  Ware,  and  Diamond  Cutting         -  88 

How  is  Lead  Poisoning  caused  ?  -           -  92 

Fume      -------  97 

Lead  or  its  Compounds  in  the  Form  of  Dust  97 
Onset  of  Symptoms,  and  its   Relation  to  Ex- 
posure to  Lead   -           -           -           -           -  102 

Channels  of  Entrance  of  the  Poison   -           -  113 

Symptomatology        -           -           -          .-           -  122 

The  Blood  in  Saturnine  Poisoning        -           -  123 

Blue  Line  on  the  Gums     -           -           -           -  132 


x  CONTENTS 

PAGE 

Colic  and  Constipation                   -           -           -  136 

Types  of  Industrial  Plumbism      -           -           -  140 

Headache         -           -           -           -           -           -  141 

Plumbism  and  Loss  of  Vision        -           -           -  143 

Nervous  System         -  147 

Sensory  Symptoms     -----  154 

Saturnine  Pseudo-General  Paralysis  :  Wasser- 

mann  Reaction    -----  156 

General  Pathological  Review  of  the  Subject  161 

What  Amounts  of  Lead  are  Harmful?            -  165 

Lead  and  Female  Life         -           -           -           -  176 

Lead  and  Motherhood        •  176 

Blood-Pressure  Experiments        -           -           -  185 

Blood  Pressure  and  Working  in  Lead-           -  189 
Chemical   Examination  of  the  Urine  and  of 

the  Organs  of  the  Body  for  Lead  -           -  192 
Anomalous  Symptoms  due  to  Drinking  Water 

Contaminated  by  Lead  -           -           -           -  193 

What  Constitutes  Lead  Poisoning?       -           -  196 

Treatment  :  Preventive      -  201 

Treatment:  Curative           ....  209 

Factory  and  Workshop  Orders  -           -           -  225 

Index    -....-           -           -           -           -           -  288 


LEAD    POISONING 

FROM  THE  INDUSTRIAL,  MEDICAL,  AND 
SOCIAL  POINTS  OF  VIEW 

Of  the  various  metals  used  in  the  arts  and  manu- 
factures, none  has,  next  to  iron,  a  wider  application 
than  lead.  Colours  made  from  lead  were  in  use 
long  before  the  Christian  era.  When  indiscrim- 
inately employed,  lead  and  its  compounds  may 
become  a  source  of  much  suffering.  The  number 
of  trades  in  which  the  metal  and  its  compounds 
are  used  is  large.  A  few  years  ago  Layet,  a  French 
physician,  enumerated  in  industries  in  which 
lead  is  employed  ;  but,  as  new  trades  are  being 
constantly  developed,  there  is  a  growing  demand 
for  lead  in  one  form  or  another.  There  are  few 
industries,  therefore,  with  which  the  metal  is  not 
directly  or  indirectly  concerned. 

Lead  mining  and  lead  smelting  are  old  British 
industries.  Blocks  of  metallic  lead  have  been 
found  in  the  Midlands  with  the  Roman  arms 
stamped  upon  them.     The  world's  production  of 


2  LEAD  POISONING 

pig  lead  is  estimated  to  be  upwards  of  1,200,000 
tons  per  year.     In  our  own  country  lead  mining 
is  confined  to  Derbyshire  and  the  North  of  Eng- 
land, also  to  the  Lowlands  of  Scotland.   Formerly 
it  was  an  important  industry  and  a  source  of  great 
wealth.    After  the  discovery  and  introduction  into 
this  country  of  Spanish  and  Australian  lead,  the 
mining  of  the  metal  in  Great   Britain   declined, 
owing  to  small  prices  and  the  fact  that  the  foreign 
ores  contained  larger  percentages  of  silver.  Within 
recent  years  there  has  been  a  revival  of  lead  mining 
in  the  North  of  England.  As  the  mining  is  carried 
on  in   the  remote  dales  and  sparsely  -  populated 
moorland  districts  of  the  northern  counties,  where 
housing  accommodation    is    inadequate,   barracks 
have  been  erected  for  the  men  to  sleep  in.  Housing 
conditions  are  better  now  than  they  were  years 
ago.     At  that  time,  when  the  mines  were  in  full 
working  order,  the  barracks  were  hotbeds  of  tuber- 
culosis.    The  rooms  were  ill-ventilated  and  over- 
crowded ;    the  windows  did  not  open ;    the  beds 
were  arranged  in  rows  too  close  to  each  other. 
No  sooner,  almost,  were  the  beds  vacated  than  they 
were  occupied  by  men  coming  in  from  the  other 
shift.     Indiscriminate  spitting  was  common,  and, 
as  many  of  the  miners  suffered  from  bronchitis, 
the  expectoration  was  freely  distributed  upon  the 
floor.     Others,  who  lived  at  home,  were  obliged, 


INTRODUCTORY  3 

when  heated  and  tired  after  their  hard  day's  work, 
to  walk  two  or  three  miles  across  a  bleak  and 
wind-swept  country,  exposed  to  the  weather. 
Hence  the  prevalence  of  bronchial  affections  in 
lead  miners,  and  a  preparation  of  the  lungs  for 
the  reception  of  tubercle  bacilli.  Lead  mines, 
unlike  coal  mines,  are  not  ventilated.  Some  of 
them  are  wet  and  are  entered  by  a  drift.  Entrance 
into  and  exit  from  other  mines  can  only  be 
accomplished  by  means  of  a  series  of  ladders. 

Since  there  are  no  inflammable  gases  in  lead 
mines,  the  men  work  with  naked  candles.  Gun- 
powder is  the  explosive  used  to  bring  down  the 
rock.  Where  powder  has  been  fired,  it  requires 
a  long  time  for  the  smoke  to  clear  away  and  for 
the  dust  to  settle.  Miners  who  work  in  such  an 
atmosphere  become  liable  to  bronchial  and  pul- 
monary catarrh,  and  especially  to  that  type  of 
lung  disease  caused  by  dust,  known  as  silicosis, 
in  which  the  spongy  texture  of  the  lung  becomes 
converted  into  fibrous  tissue.  Miners  who  are 
the  subjects  of  silicosis  incur  the  risk  of  having 
tubercle  subsequently  grafted  upon  the  injured 
lungs.  Statistics  show  that  pulmonary  tuber- 
culosis is  more  prevalent  among  lead  miners  than 
among  other  persons  living  in  the  same  district. 
Owing  to  the  wetness  of  the  mines,  the  men  are 
liable  to  rheumatism. 


J 


4  LEAD  POISONING 

Apart  from  these  maladies,  lead  miners  are  not 
an  unhealthy  class  of  men.  Socially  they  are  a 
contented  body  of  men,  frugal,  temperate,  and 
thrifty.  They  do  not  suffer  from  lead  poisoning, 
because  the  lead  in  the  ore  is  in  almost  the  pure 
metallic  form,  known  as  galena.  This  exemption 
from  plumbism  does  not  apply  to  lead  miners  all 
the  world  over.  A  decade  and  a  half  ago,  at  the 
Broken  Hill  Mines  in  Australia,  several  of  the 
miners  suffered  severely — there  were  even  a  few 
deaths — owing  to  the  ore  being  in  the  form  of 
carbonate.  This  ore,  known  as  cerussite,  is,  prac- 
tically speaking,  a  crude  white  lead.  It  differs 
in  composition  from  the  ordinary  white  lead  of 
commerce  in  the  fact  that,  while  <  the  manu- 
factured article  is  a  hydrated  lead  carbonate 
or  a  mixture  of  hydrate  and  carbonate,  cerussite 
is  crystallized  lead  carbonate.  The  ore  is  friable, 
breaks  down  readily  into  a  fine  powder,  is  easily 
blown  about  the  mine  in  the  form  of  fine  dust, 
and  possesses,  therefore,  all  the  dangerous  proper- 
ties of  the  white  lead  of  commerce.  The  men 
who  mined  the  cerussite  suffered  heavily  in  their 
health  ;  and  no  wonder,  since  in  the  sputum  of 
three  of  them  2*o,  r8,  and  i"6  grains  of  lead  were 
found  respectively.  The  200-foot  layer  of  carbonate 
ore  at  Broken  Hill  has  been  pretty  well  exhausted, 
so  that  at  Broken  Hill,  as  in  England,  the  ore  now 


LEAD  SMELTING  5 

raised  is  sulphide,  or  galena,  and  as  a  consequence 
lead  poisoning  among  the  miners  has  disappeared. 

Lead  Smelting 

From  lead  poisoning — or,  as  it  is  sometimes 
called,  saturnism,  phimbism,  colica  pictonum,  and 
colica  pictofum — the  British  miner,  as  just  stated, 
is  free.  The  risk  to  health  and  life  commences 
with  smelting  of  the  ore.  People  when  travelling 
through  lead-mining  districts  may  have  noticed 
here  and  there  a  tall,  solitary  chimney-stack  on  a 
hill-top,  far  removed  from  other  buildings.  Such 
a  stack  is  usually  the  chimney  by  which  fume 
generated  during  the  smelting  of  lead  escapes 
from  a  lead  works  which  may  be  situated  in  the 
hollow  a  mile  or  more  away.  By  means  of  an 
underground  flue  or  series  of  flues  3  to  4  feet  high, 
and  made  of  brick  or  wood,  the  smoke  and  fume 
from  the  smelting  furnace  are  conveyed  into  the 
open  air.  The  fumes  which  escape  from  the  stack 
are  dangerous.  For  a  considerable  radius  round  a 
stack  cattle  must  not  graze.  Both  at  home  and 
on  the  Continent  lead  manufacturers  have  had 
to  pay  heavy  damages  to  farmers  and  owners  of 
stock  for  injury  done  to  the  herbage,  and  for  the 
death  of  animals  which  had  grazed  in  the  im- 
mediate vicinity  of  the  stack.  The  flues  are 
sometimes    of    a    sufficient    height    for    men    to 


6  LEAD  POISONING 

enter  so  as  to  remove  the  dust,  which  is  rich  in 
lead. 

However  injurious  to  the  surrounding  country 
fumes  escaping  from  lead-smelting  works  may  be, 
they  are  a  serious  menace  to  the  health  and  life 
of  human  beings  and  animals  when  the  works  are 
near  a  town.  Broken  Hill  in  New  South  Wales 
supplies  an  illustration.  The  consequences  of 
having  allowed  dwelling  -  houses  to  be  built  in 
close  proximity  to  lead-smelting  works  are  there 
so  evident  that  the  experience  about  to  be  de- 
tailed should  be  a  warning  to  all  prospectors  and 
managers  of  mining  companies  about  to  erect 
plant  on  virgin  land. 

In  1892  there  were  employed  in  the  Broken 
Hill  Mines  and  Works  4,445  men.  More  than 
half  of  these  worked  on  the  surface.  Around  the 
works  and  within  a  radius  of  twelve  miles  there 
had  grown  up  within  five  years  a  town  with  a 
population  of  22,500.  Five  thousand  of  these 
people  lived  in  a  district  called  South  Town,  and 
were  exposed  to  the  fumes  escaping  day  and  night 
from  the  smelter  stacks.  Outside  of  the  town 
the  country  is  a  waterless  wilderness  of  salt  bush 
country,  almost  uninhabited.  Here  sheep-farming 
is  hazardous.  During  five  years — 1888  to  1892 — 
there  were  2,132  cases  of  lead  poisoning  of  human 
beings,  with  n  deaths,  at  Broken  Hill.    Owing  to 


LEAD  SMELTING  7 

the  comparatively  low  temperature  at  which  lead 
volatilizes,  the  amount  of  fume  poured  forth 
from  the  twenty-eight  smelters,  each  of  80  tons 
capacity,  during  twenty-four  hours,  was  estimated 
to  be  equal  to  15  tons  weight  of  the  metal  used. 
Some  of  the  fume  in  a  finely  attenuated  form 
would  float  away  to  a  considerable  distance,  while 
the  remainder,  consisting  of  heavier  particles, 
would  become  deposited  near  the  stacks.  Samples 
of  air  tested  a  short  distance  from  the  stacks 
gave  7>V  grain  of  lead  per  cubic  foot,  equivalent 
to  52  grains  per  1,000  cubic  feet  of  air.  From 
glycerin-coated  plates  placed  outside  one  of  the 
hotels  in  the  town  there  was  collected,  after  eight 
hours,  3^-  grains  of  lead,  with  traces  of  arsenic, 
per  square  foot  of  surface.  The  fume  penetrated 
into  the  houses,  and  it  contaminated  reservoirs 
of  drinking  water  to  such  an  extent  that  in  one 
sample  \  grain  of  lead  per  gallon  was  found,  and  in 
another  5  J  grains  of  lead  per  gallon.  Although  only 
eleven  fatal  cases  of  acute  lead  poisoning  occurred 
during  the  five  years  alluded  to,  yet  plumbism 
must  have  been  the  cause  of  much  illness  of  a 
chronic  nature  and  of  an  extent  difficult  to  estimate. 
So  bespoiled  were  the  gardens  that  a  child  two 
and  a  half  years  old,  who  had  plucked  flowers  and 
sucked  them,  died.  On  the  flowers  lead  was  found. 
Similarly,  milch  cows  kept  within  a  radius  of  one 


8  LEAD  POISONING 

to  two  miles  died  from  lead  poisoning.  Among 
cats,  dogs,  and  fowls,  the  mortality  was  extremely 
high.  In  the  bodies  of  a  horse,  a  dog,  and  a  fowl, 
lead  was  found.  There  are  sparrows  at  Broken 
Hill,  but  other  birds  are  rare.  Cage-birds  can  be 
kept,  but  only  so  long  as  the  sand  which  is  placed 
in  the  cages  is  brought  some  miles  away  from  the 
town. 

Dogs  kept  at  a  smelting  works  in  the  neigh- 
bourhood of  Newcastle-upon-Tyne  developed  a 
peculiar  train  of  symptoms.  They  would  run 
round  and  round,  become  convulsed,  and  drop 
down  dead.  These  circus  movements  in  plumbism 
are  confined  to  animals.  Wild  birds  which  had 
eaten  berries  grown  in  close  proximity  to  lead- 
smelting  works  have  been  picked  up  dead.  These 
are  minor  matters  compared  with  the  condition  of 
things  which,  as  already  stated,  existed  a  few 
years  ago  at  Broken  Hill,  where  dogs  and  kittens 
were  with  difficulty  reared  and  cage-birds  kept. 
Poultry  also  died  ;  hens  gradually  became  emaci- 
ated and  ceased  to  lay  eggs.  Women,  married 
and  unmarried,  suffered  from  menstrual  disorders : 
abortion  and  premature  births  were  frequent.  At 
a  large  lead  and  zinc  smelting  works  on  the  Con- 
tinent, with  a  frontage  to  a  canal,  the  manager 
informed  me  that  the  ducks  belonging  to  his 
workpeople  became  paralyzed  in  their  limbs,  so 
that  they  could  no  longer  paddle. 


LEAD  SMELTING  9 

The  dangers  of  lead  smelting  are  now  better 
known  than  formerly,  and  employers  are  taking 
greater  pains  to  prevent  fume  escaping.  There 
are  economic  reasons  why  they  should  do  so. 
Since  owners  of  lead-smelting  works  have  in- 
creased the  length  of  the  flues  there  have  been 
fewer  claims  for  compensation  by  farmers  than 
formerly.  The  bulk  of  the  fume  and  smoke 
given  off  during  smelting  becomes  deposited  in 
the  flues,  so  that  only  a  minimum  escapes  from 
the  chimney-stacks,  and,  as  these  are  frequently 
ioo  or  150  feet  high,  the  fume  is  widely  dispersed 
in  an  attenuated  form  by  aerial  currents. 

As  the  symptoms  of  lead  poisoning  in  cattle 
differ  from  those  observed  in  man,  differ,  too, 
between  horses  and  oxen,  and  are  perhaps  not 
well  known  to  the  reader,  it  may  be  well  for  me 
to  reproduce  here  the  symptomatology  given  by 
Mr.  Daniel  Parr,  veterinary  surgeon,  in  his 
evidence  before  the  Broken  Hill  Lead  Inquiry 
Commission.  As  regards  horses,  the  symptoms 
in  the  early  stages  are  loss  of  appetite,  coldness  of 
the  limbs  and  ears,  a  tucked-up  appearance  of  the 
barrel,  pulse  46  (a  slight  increase  above  the 
normal),  rectal  temperature  101/50  to  1020  F.,  and 
the  head  depressed.  At  this  period  of  the  illness 
there  are  no  indications  of  the  animals  having 
colic.     Later  on  a  grey  discharge  oozes  from  the 


io  LEAD  POISONING 

nostrils,  there  is  excessive  flow  of  saliva,  and  the 
animals  keep  champing  their  jaws.  In  a  still 
later  stage  breathing  becomes  laboured ;  some- 
times it  is  so  difficult  that  the  animal  seems  as 
if  he  were  being  suffocated,  while  the  exhaled  air 
has  an  extremely  unpleasant  odour.  There  are 
tremors,  perspiration,  and  restlessness.  The 
animal  keeps  lying  down  and  rising  up  as  if 
in  pain.  By  this  time  the  breathing  has  prob- 
ably become  irregular  and  more  difficult.  There 
is  frequent  micturition,  small  quantities  of  urine 
being  passed  every  few  minutes.  The  horse  keeps 
walking  round  and  round  until  he  loses  control  of 
his  movements;  he  staggers,  falls  down  in  con- 
vulsions, and  in  three  or  four  minutes  he  is  dead. 
At  death  the  temperature  may  be  1060  or  1070  F. 
In  cattle  loss  of  appetite  is  one  of  the  early 
symptoms  of  plumbism.  The  cow  ceases  to  chew 
the  cud  ;  she  stands  apart  from  the  herd,  becomes 
restless,  the  eyes  stare  and  the  pupils  are  dilated. 
There  are — foaming  at  the  mouth ;  pulse  65, 
slightly  quicker  than  the  normal ;  a  rectal  tem- 
perature of  1030  F.,  with  respiration  25 — i.e., 
10  above  the  normal.  The  muscles  of  the  face 
and  shoulders  become  the  seat  of  spasmodic 
twitching.  Later  on  the  animal  is  observed  to 
run  round  and  round,  or  to  rush  forward,  dashing 
her  head  to  right  or  left,  as  if  suffering  from  an 


LEAD  SMELTING  n 

inflammatory  affection  of  the  brain.  In  still 
later  stages  the  pulse  is  found  to  have  risen  to  80 
or  more.  There  are  grinding  of  the  teeth,  champ- 
ing of  the  jaws,  a  free  flow  of  saliva  from  the 
mouth,  and  indications  of  abdominal  pain.  Con- 
vulsions supervene,  and  in  these  the  animal  dies. 
In  other  instances  the  breathing  becomes  laboured, 
and  the  cow  dies  gasping  for  breath,  or  she  simply 
lies  down,  closes  her  eyes,  and  dies  in  coma,  death 
being  preceded  by  a  marked  fall  of  the  tempera- 
ture. Parr  found  that  25  per  cent,  of  the  cows 
which  became  lead-poisoned  died,  and  that,  on 
account  of  the  expense,  the  length  of  time 
required  to  be  restored  to  health,  and  the  after- 
effects of  the  plumbism — viz.,  uselessness  of  the 
cows  as  milkers  for  long  afterwards — it  was  hardly 
worth  while  trying  to  recover  them. 

Lead  can  be  smelted  by  various  methods,  of 
which  two  alone  need  be  described.  Refractory 
and  dross  ores  are  treated  in  blast-furnaces,  with 
hearths  for  removal  of  the  lead  and  slag  at  the 
bottom.  Each  furnace  is  fed  from  above  with 
coke  and  ore.  Xix  is  driven  into  the  lower  part  of 
the  glowing  charge  by  a  strong  blast.  By  the 
upper  part  of  the  furnace  smoke  and  fume  escape 
into  one  of  the  main  flues,  while  the  molten  metal 
and  the  slag  collect  in  the  hearth  and  are  run  off 
periodically.     There  is  a  danger  of  the  flue  becom- 


12  LEAD  POISONING 

ing  partially  blocked,  and  of  the  fumes  being 
reflected  upon  the  workmen,  by  which  may  be 
explained  such  signs  of  plumbism,  exhibited  by 
smelters,  as  tremors,  paresis  or  paralysis  of  the 
arms  and  hands,  anaemia,  and  the  presence  of  a 
blue  line  on  the  gums.  The  furnace-men  also 
run  the  additional  risk  of  having  their  health 
affected  by  the  inhalation  of  carbon  monoxide, 
which  is  given  off  during  the  incomplete  combus- 
tion of  the  fuel.  The  percentage  by  volume  of 
carbon  monoxide  escaping  from  lead  blast-fur- 
naces varies  from  3 '5  to  io'8.  As  lead  melts  at 
325°  C.  (6170  F.),  its  vapour  is  given  off  at  the 
ordinary  heat  of  the  furnace. 

In  the  Scotch  hearth,  which  is  smaller  than  the 
English  blast-furnace,  only  galena  is  treated. 
The  furnace  is  an  open  hearth.  Upon  this  work- 
men place  the  charge.  Two  blast-pipes  open  into 
the  charge  from  the  back  of  the  hearth.  As  the 
molten  metal  rises  to  the  top  of  the  well,  or  sump, 
of  the  hearth,  it  flows  off  by  a  small  channel  into  a 
collecting  pot  in  front  of  the  furnace.  The  slag 
is  also  run  off  periodically  into  water  and  cooled. 
Fumes  are  given  off  during  each  of  these  pro- 
cesses. Usually  there  is  a  sufficient  amount  of 
lead  left  in  the  slag  to  render  it  worth  while  being 
remelted.  Workmen,  in  breaking  up  the  slag 
with  a  hammer,  raise  clouds  of  dust,  which  settles 


LEAD  SMELTING  13 

upon  the  timbers  of  the  smelting  shop,  the 
clothes  of  the  workmen,  and  upon  any  parcels  of 
food  the  men  may  have  brought  with  them.  Dr. 
Edgar  Collis,*  His  Majesty's  Medical  Inspector  of 
Factories,  basing  his  opinion  upon  an  analysis  of 
the  fumes,  maintains  that  in  eight  hours  a  man 
thus  employed  might  inhale  y^S  grains  of  lead.  It 
is  not,  of  course,  maintained  that  he  does  inhale 
this  quantity.  Of  thirty-two  blast-furnace  men 
examined,  Dr.  Collis  found  in  twenty-two  a  blue 
line  on  the  gums,  and  in  twelve  of  the  men  weak- 
ness of  the  extensor  muscles  of  the  hands  and 
fingers. 

Cleaning  out  the  flues  is  a  dangerous  occupa- 
tion, on  account  of  the  large  quantities  of  lead 
which  the  dust  contains.  Lead  fume,  as  indi- 
cated, is  the  volatile  metallic  vapour  given  off 
from  the  molten  metal  in  the  furnace  when 
brought  into  contact  with  atmospheric  air,  also 
from  the  lead  itself  at  extremely  high  tempera- 
tures, such  as  1,200°  C.  ;  but  flue-dust,  accord- 
ing to  the  quality  of  the  lead  ore  used,  is  com- 
posed of  particles  of  coke  or  unburnt  carbon, 
silver,  arsenic,  antimony,  reduced  globules  of 
metallic  lead,  lead  in  the  form  of  oxide  and 
sulphate,  also  quartz  and  limestone.  Flue-dust  is 
worth  recovering,  for  it  may  contain  as  much  as 

*  "Special  Report  on  Dangerous  and  Injurious  Processes." 


14  LEAD  POISONING 

30  per  cent,  of  metallic  lead.  Hoffman*  found 
that  flue-dust  contained  as  lead  o"8  to  15  per  cent, 
of  the  weight  of  the  ore  charged.  In  some  of  the 
lead  works  on  the  Continent  of  Europe  flue-dust 
contains  16  to  26  per  cent,  of  lead,  and  as  much 
as  7  per  cent,  of  arsenic.  To  recover  the  lead 
deposited  in  the  dust,  workmen  enter  the  flues  by 
manholes  placed  here  and  there  along  their  course. 
In  places  2  feet  or  more  of  dust  may  be  found 
deposited  in  the  flues,  the  removal  of  which  by 
the  shovel  raises  clouds  of  dust.  To  work  in 
such  a  dusty  atmosphere,  the  men  are  obliged 
to  wear  respirators.  It  is  undesirable  that  the 
men  should  carry  on  this  work  for  more  than 
two  hours  without  a  break.  If  respirators  are 
not  worn,  the  men  suffer  from  severe  headache 
and  feel  extremely  ill.  Serious  symptoms  develop 
in  men  who  have  worked  only  a  few  days 
in  the  flues.  At  a  large  lead  works  with  which 
I  am  familiar,  two  days  were  set  aside  recently 
for  cleaning  out  the  flues.  Of  thirteen  men 
told  off  to  do  so,  two  of  them  on  the  second 
day  suffered  from  vomiting,  diarrhoea,  and  severe 
headache,  accompanied  by  a  rise  of  tempera- 
ture to  1020  F.  For  a  few  days  the  men 
were  very  ill.  Last  summer,  when  in  Allendale, 
I  noticed  upon  a  hillside  some  distance  away  a 
*  Engineering  and  Mining  jQurnal,  1906,  p.  380. 


LEAD  SMELTING  15 

tall  chimney-stack  which  was  showing  signs  of 
decay.  Dr.  Murray  of  Allendale  pointed  out  to 
me  the  smelting  works  of  which  it  was  a  part,  and 
which  were  quite  a  mile  away  from  the  chimney- 
stack.  He  gave  me  the  following  information : 
During  the  winter  of  1912-13  he  had  treated  two 
men  for  acute  plumbism ;  both  of  them  suffered 
from  a  sharp  attack  of  colic.  For  upwards  of 
twenty  years  the  smelting  works  had  lain  idle. 
It  was  known  that  the  flues  leading  to  the  chim- 
ney-stack contained  large  quantities  of  deposit 
rich  in  lead.  The  two  men  referred  to  had  under- 
taken to  recover  this,  and  had  entered  the  flues  by 
manholes.  They  had  only  worked  two  or  three 
days,  when  they  suffered  so  severely  that  they 
were  obliged  to  give  up  the  work.  Where  flues 
are  closely  packed  and  are  on  the  slope,  if  the 
incline  is  sufficient,  it  is  safer  to  flush  them  out 
with  water,  and  allow  the  contents  to  run  into 
reservoirs  wherein  the  material  can  settle.  Lead 
and  its  compounds  in  the  form  of  sludge  are  less 
dangerous  to  the  workmen  than  the  dry  dust 
shovelled  out  of  the  flues. 

Lead  as  it  comes  from  the  furnace  is  not  always 
pure  metal ;  it  may  contain  silver,  gold,  antimony, 
and  other  adulterants,  which  have  to  be  removed. 
The  two  best  -  known  methods  for  removing 
these  are  the  Pattinson  and  the  Parkes  processes. 


1 6  LEAD  POISONING 

On  Tyneside,  the  home  of  its  introduction,  the 
Pattinson  process  is  mostly  in  use.  The  method 
is  based  upon  the  fact  that  lead  crystallizes  at  a 
higher  temperature  than  a  mixture  of  lead  and 
silver,  so  that  the  crust  which  forms  on  the 
surface,  and  which  contains  lead  and  silver,  is 
skimmed  off  from  time  to  time  for  further  separa- 
tion and  purification.  In  Parkes'  process  zinc  is 
added  to  the  lead.  This  in  the  melting-pot  forms 
an  alloy  of  lead,  zinc,  and  silver,  which  rises  to  the 
surface  of  the  molten  metal,  and  can  be  skimmed 
off.  The  further  stage  of  the  process  consists  in 
separating  these.  The  zinc  is  drawn  off  in  the 
form  of  vapour  in  a  dezincking  apparatus,  such  as 
the  Faber  du  Four  retorting  furnace.  During  the 
process  of  dezincking,  zinc  as  well  as  lead  fumes 
escape,  and  if  the  furnace-men  inhale  these 
fumes  they  are  liable  to  suffer  from  nausea. 
Men  employed  in  desilvering  lead  have  frequently 
come  under  my  care  on  account  of  plumbism,  but 
on  the  whole  fewer  men  thus  employed  have 
sought  my  advice  than  men  engaged  in  some  of 
the  other  departments  in  lead  works. 

Allusion  has  been  made  to  workmen  suffering 
from  nausea  as  a  consequence  of  inhaling  zinc  and 
lead  fumes  during  dezincking  of  the  lead  alloy. 
The  smelting  of  zinc  is  of  itself  a  frequent  source 
of  plumbism,  for  zinc  ores  frequently  contain  lead, 


LEAD  SMELTING  17 

Calamine  ore  contains  44  to  60  per  cent,  of  zinc  in 
the  form  of  carbonate,  but  in  blende  ore,  in  addition 
to  the  zinc  which  is  present  in  the  form  of  sulphide, 
there  may  be  lead  to  the  extent  of  9*3  to  18  per 
cent.    In  making  spelter,  blende  ore  is  roasted  in  a 
calcining  furnace  in  order  to  drive  off  the  sulphur  ; 
the  residue  may  contain  1  to  10  per  cent,  of  lead. 
To  the  burnt  blende,  calamine  ore,  zinc  ashes,  zinc 
oxide  and  chloride  obtained  from  the  skimmings 
of  galvanized  pots  and  retort  crucibles,  are  added. 
Anthracite  is  also  added,  and  the  charge  is  placed 
in  retorts  and  exposed  to  a  high  temperature.     The 
zinc  distils  over,  and  is  condensed  in  a  crucible 
close  to  the  retort.     Not  only  are  the  workmen 
exposed  to  the  influence  of  a  high  temperature, 
but  they  inhale  fumes   of  lead  and  zinc,  and  in 
addition  breathe  an  atmosphere  rendered  injurious 
and  irritating  to  the  lungs  and  bronchi    by  the 
sulphur  dioxide  given  off  at  the  same  time.     Con- 
sidering the  small  percentage  of  lead  present  in 
some    samples    of  spelter,    often    not   more    than 
2  per  cent.,  plumbism  is  extremely  frequent  among 
the  workmen.    Between  July  1,  1907,  and  Decem- 
ber 31,  1912,  there  were,  according  to  Home  Office 
returns,  77  cases  of  lead  poisoning  among  spelter 
workers  in  South  Wales  alone.   German  physicians 
state  that   spelter  workers  are   old   and   broken 

2 


1 8  LEAD  POISONING 

down  at  forty.  To  the  zinc  fumes  given  off  in 
spelter  works  are  attributed  the  bronchitis,  gastric 
and  intestinal  troubles,  from  which  the  men  suffer, 
while  to  the  lead  fumes  are  attributed  the  nervous 
affections ;  but  where  two  kinds  of  metallic  fumes 
are  being  inhaled  simultaneously  it  is  difficult  to 
assign  to  each  its  proper  share  in  the  causation  of 
symptoms. 

Manufacture  of  Red  Lead 

Red  lead,  or  minium  (Pb304),  is  a  mixture  of 
PbO  with  varying  amounts  of  Pb203.  It  is  pre- 
pared by  placing  pure  lead  in  the  open  hearth  of  a 
reverberating  furnace  and  heating  it  to  a  dull  red- 
ness. During  the  process  the  material  is  raked 
from  time  to  time.  By  slow  oxidization  the  lead 
is  converted  into  lead  oxide  (PbO).  This,  known 
as  litharge  or  massicot — a  green-looking  substance 
— becomes  yellow  or  yellowish-red  on  being  washed. 
After  having  been  washed  so  as  to  remove  any 
pieces  of  unoxidized  lead,  the  massicot  is  again 
heated,  but  at  a  lower  temperature,  when,  owing 
to  further  oxidization,  the  massicot  changes  its 
colour  to  a  bright  red,  and  is  called  minium,  or 
red  lead.  If  the  flue  of  the  furnace  is  not  drawing 
well,  or  if  the  mouth  of  the  furnace  is  not  well 
hooded,  the  fumes  may  be  reflected  upon  the  work- 
men during  the  oxidizing  processes  just  mentioned. 


MANUFACTURE  OF  RED  LEAD  19 

Clouds  of  red  dust  invariably  arise  during  the 
raking  out  of  the  finished  product  from  the 
furnace. 

In  the  cupelling  of  lead,  a  blast  of  air  is  blown 
upon  the  molten  metal  in  the  furnace.  The  lead 
thus  oxidized  is  by  the  force  of  the  blast  driven  off 
the  surface  of  the  metal  into  a  receiver.  In  the 
act  of  cooling  the  metal  exfoliates.  It  breaks  up 
into  fine  crystalline  scales  like  coarse  bran,  known 
in  the  trade  as  flaked  litharge.  The  process  is 
carried  out  at  extremely  high  temperatures. 
When  the  inner  door  of  the  furnace  is  opened, 
considerable  quantities  of  fume  escape,  and,  as  this 
cannot  all  be  carried  off  by  the  hooded  exhaust 
which  leads  into  the  flue,  the  workmen,  unless  they 
stand  well  back  at  that  particular  moment,  are 
likely  to  be  enveloped  in  fume  and  to  run  the  risk 
of  inhaling  some  of  it.  Between  1900  and  1909 
twenty-five  men  engaged  in  this  work  became  ill 
through  the  effects  of  lead.  The  flues  from  the 
cupelling  furnaces  at  one  of  the  works  which  I 
recently  visited  are  cleaned  out  once  a  year.  In- 
side the  flues  there  is  a  deposit  of  dust  5  to 
6  inches  deep.  This  dust  contains  50  per  cent,  of 
lead.  Some  physicians  regard  the  manufacture 
and  use  of  red  lead  as  only  slightly  dangerous  to 
the  health  of  workmen.  Such  is  not  my  experi- 
ence, nor   is   it  that  of  Medical  Inspector  E.  R. 


20  LEAD  POISONING 

Stitt,*  of  the  United  States  Navy,  who  reports  the 
admission  into  the  United  States  Naval  Hospital, 
Canacao,  P. I.,  of  three  seamen  suffering  from  the 
encephalopathic  type  of  plumbism,  due  to  inhala- 
tion of  red  lead  dust  rising  from  dried  surfaces 
when  being  chipped  preparatory  to  being  re- 
painted. But  for  the  assistance  obtained  by  a 
microscopical  examination  of  the  blood,  and  the 
finding  therein  of  punctated  erythrocytes,  Stitt 
admits  that  the  diagnosis  might  have  been  diffi- 
cult, although  the  presence  of  a  blue  line  on  the 
gums  was  extremely  suggestive  of  plumbism.  One 
of  his  patients  became  insane  and  had  to  be  re- 
moved to  an  asylum,  from  which,  after  a  consider- 
able length  of  time,  he  was  discharged  cured. 
Another  of  the  men  had  colic  ;  there  was  a  blue 
line  on  his  gums,  and  in  his  blood  basophilia. 
He  developed  severe  epileptiform  convulsions. 
These  ceased ;  by  degrees  the  anaemia  which  he 
showed  and  the  tremors  he  suffered  from  disap- 
peared. The  men  had  been  chipping  red  paint  in 
the  compartments  of  torpedo  boats.  Stitt's  cases 
lend  support  to  the  opinion  I  have  expressed,  that 
extremely  severe  forms  of  plumbism  are  met  with 
in  red  lead  workers. 

Between    1900    and    1912    there   occurred    in 

*  U.S.  Naval  Medical  Bulletin,  April,  1912,  p.  161.     Wash- 
ington Government  Printing  Office. 


MANUFACTURE  OF  RED  LEAD  21 

British  red  lead  factories  134  cases  of  plumbism.* 
In  one-fourth  of  the  men  the  symptoms  were 
severe.  Sixteen  of  the  men  who  had  been  ill  had 
been  introduced  into  red  lead  works  simply  as 
labourers  to  sweep  up  the  floors.  During  the 
sieving,  grinding  and  packing  of  litharge,  clouds 
of  dust  rise.  Thirteen  of  the  cases  above  referred 
to  were  furnace-men.  One  patient  was  a  brick- 
layer who  was  reconstructing  a  flaked  litharge 
furnace.  He  contracted  lead  poisoning,  and  died 
from  it.  In  one  of  the  factories  on  the  Continent 
a  man  who  was  carrying  a  small  barrel  of  red  lead 
let  the  barrel  fall.  It  broke.  Immediately  the 
workman  was  enveloped  in  a  cloud  of  red  dust. 
Symptoms  of  acute  plumbism  developed,  followed 
by  paralysis  of  the  extensor  muscles  of  the  wrists 
and  fingers,  which  persisted  for  several  months. 

Red  lead  is  also  manufactured  by  automatic 
processes,  but,  as  the  machinery  is  more  or  less 
patented,  a  description  of  it  cannot  be  given. 
Suffice  it  to  say  that  from  the  time  the  pig  lead  is 
fed  into  the  closed  melting-pot  at  one  end,  and 
where  it  is  converted  primarily  into  monoxide,  also 
during  its  passage  onwards  through  the  colouring 
ovens  to  the  place  where  it  falls  as  finished  red 
lead  into  the  barrels  for  packing   purposes,    the 

*  "Special    Report   on    Dangerous    and    Injurious    Pro- 
cesses," by  Dr.  Edgar  Collis. 


22  LEAD  POISONING 

material  is  never  handled  by  the  men.  Since 
there  is  a  minus  pressure  inside  the  conduits,  no 
dust  is  given  out  at  any  part  of  the  machinery 
where  the  joints  have  become  loose.  By  this 
method  of  manufacture  fewer  workmen  are  re- 
quired, the  atmosphere  is  clearer,  and  the  men  run 
no  risk  except  at  the  hopper  where  the  red  lead 
falls  into  the  barrels.  When  this  part  of  the 
machinery  is  effectively  screened,  the  manufacture 
of  red  lead  becomes  an  industry  remarkably  free 
from  many  of  the  risks  hitherto  incidental  to  it. 

Manufacture  of  White  Lead,  or  Lead 
Carbonate 

Notwithstanding  the  opposition  in  many  quar- 
ters to  the  use  of  white  lead,  there  is  still  a  great 
demand,  if  not  an  increasing  one,  for  the  pig- 
ment. It  is  estimated  that,  in  1910,  58,000  tons  of 
white  lead  were  manufactured  in  this  country,  and 
that  14,500  tons  were  imported  from  abroad.  In 
Great  Britain  this  particular  department  of  the 
industry  gives  employment  to  2,500  men,  while 
the  capital  invested  for  manufacturing  purposes 
cannot  be  far  short  of  £1,500,000.  In  the  United 
States  of  America  the  manufacture  of  white  lead 
was  begun  in  1777.  The  annual  production  of 
white  lead  in  the  States  is  100,000  tons. 


MANUFACTURE  OF  WHITE  LEAD  23 

By  the  term  white  lead  is  meant  the  carbonate. 
Lead  sulphate  is  also  a  white  pigment,  but  com- 
mercially it  is  always  known  by  its  chemical 
designation.  Two  of  the  best-known  methods  of 
making  white  lead  are  (1)  the  Dutch  process,  and 
(2)  the  chamber  process.  In  the  Dutch  process 
thin  perforated  plates  of  metallic  lead,  called 
"  wickets  "  or  "  grids,"  are  taken  to  a  stack,  or 
corroding  house,  a  large  quadrilateral  space,  sub- 
sequently to  be  spoken  of  as  the  "  blue  bed,"  one 
side  of  which  opens  into  a  main  passage.  There 
are  usually  several  stacks  placed  side  by  side  in  a 
row.  On  an  average  the  stacks  are  20  feet  high 
and  16  by  13  feet.  Upon  the  floor  of  the  stack 
bark  from  a  tanyard  is  strewn  to  the  depth  of 
2  to  3  inches.  On  the  bark  are  placed  rows  of 
wide-mouthed  earthenware  jars,  6  to  7  inches 
high,  half  filled  with  a  2  to  3  per  cent,  solution 
of  acetic  acid.  The  lead  plates,  known  as 
"  wickets  "  or  "  grids,"  are  placed  sideways  on  the 
top  of  the  open  jars.  The  lead  used  must  be 
pretty  pure,  for  the  presence  of  silver,  bismuth 
and  copper  are,  from  the  white  lead  manufacturer's 
point  of  view,  impurities,  and  interfere  with  the 
results.  Upon  the  wickets  is  placed  a  layer  of 
wooden  planks.  Bark  is  strewn  upon  the  planks, 
and  on  the  tan  another  series  of  jars  containing 
acetic  acid,  and  supporting  metallic  plates,  is  laid. 


24  lead  poisoning 

Thus,  by  a  series  of  alternating  layers,  called  in 
Scotland  "heats,"  the  stack  becomes  built  up 
from  bottom  to  top,  care  being  taken,  as  the  blue 
bed  is  being  reared  and  as  each  layer  is  completed, 
to  place  planks  across  the  open  entrance,  so  as  to 
confine  the  contents.  The  making  up  of  a  blue 
bed  may  be  done  by  women.  Home  Office  regu- 
lations allow  of  this.  It  does  not  require  skilled 
labour.  An  unoccupied  space  of  a  few  feet  is  left 
at  the  top  of  the  stack,  and  at  the  sides  pipes 
are  inserted  for  the  purposes  of  ventilation,  the 
removal  of  vapour,  and  the  prevention  of  too  high 
a  temperature.  In  a  stack  there  are  usually  twelve 
layers  of  tan,  jars,  and  lead  plates,  but  in  some 
works  there  are  fifteen.  Some  managers  believe 
that  better  results  are  obtained  where  there  are 
only  twelve  rather  than  fifteen  layers.  If  the  layers 
are  too  many,  less  of  the  lead  in  the  mid-zone  of 
the  stack  is  corroded. 

Although  there  is  a  considerable  amount  of 
handling  of  the  wickets  by  the  women  who  make 
up  the  blue  bed,  the  work  is  not  regarded  as  in- 
jurious. I  have,  however,  known  of  women  suffer- 
ing from  colic  when  thus  employed.  When  the 
blue  bed  is  fully  made  up,  the  outer  doors  are 
closed,  and  the  stack  is  left  undisturbed  for  ioo 
to  130  days.  In  the  course  of  a  few  days  the 
temperature  inside  the  stack  rises.     It  may  reach 


MANUFACTURE  OF  WHITE  LEAD  25 

8o°  C,  but  manufacturers  prefer  a  lower  tempera- 
ture— 500  to  60°  C. — and  in  order  to  secure  this 
they  frequently  add,  when  making  up  the  stack, 
old  tan  to  the  new,  so  as  to  prevent  too  rapid 
fermentation.  Thompson  is  of  the  opinion  *  that 
the  fermentation,  or  decomposition,  which  takes 
place  within  the  stack  is  the  result  of  the  activity 
of  bacteria  within  the  tan,  and  that,  as  the  process 
continues,  the  part  played  in  the  initial  stages  by 
micro-organisms  is  replaced  by  combustion.  At 
the  end  of  three  months,  when  the  stack  is  opened, 
it  is  known  no  longer  as  a  "  blue,"  but  as  a  "  white  " 
bed.  Into  it  women  are  not  allowed  to  enter,  for 
the  stripping  of  the  white  lead  and  the  removal  of 
the  uncorroded  lead  are  dangerous.  During  the 
three  months  the  stack  was  closed  fermentation  of 
the  bark  had  been  going  on,  attended  by  a  rise 
of  temperature.  The  acetic  acid  had  vaporized, 
and  had  attacked  the  metallic  lead,  converting  it 
into  lead  acetate  ;  but,  as  carbonic  acid  was  at 
the  same  time  given  off  from  the  tan,  a  double 
chemical  action  had  taken  place,  whereby  the 
lead  acetate  was  converted  into  hydroxycarbonate. 
White  lead  is  a  basic  compound  containing  two 
molecules  of  normal  carbonate  of  lead  in  com- 
bination with  one  molecule  of  lead  hydrate  or  lead 
oxide,  and  it  has  the  formula  2PbC03Pb(OH)a._ 
*  Journal  of  Society  of  Chemical  Industry,  1909,  p.  28,  etc 


0 


26  LEAD  POISONING 

It  has  been  taught  that  white  lead  is  a  mechanical 
mixture  of  hydrate  and  carbonate  of  lead ;  that 
the  hydrated  portion  gives  the  spreading  power 
to  paints  made  from  the  pigment,  and  that  the 
carbonate  gives  the  opacity,  but  on  this  point 
recent  opinions  differ.  Pure  carbonate  of  lead  is 
useless  as  a  pigment.  It  is  owing  to  its  peculiar 
composition  and  the  varying  size  of  its  molecules 
that  it  combines  so  well  with  oil  "  as  to  confer 
upon  it  as  a  paint  that  smooth  working  quality 
in  the  brush  which  enables  painters  readily  to  pro- 
duce a  smooth  and  uniform  coat,  rendering  it  water- 
shedding  and  resistant  to  decay  "  (Noel  Heaton). 

Corrosion  or  conversion  of  the  metallic  lead 
into  carbonate  is  never  quite  complete.  There  is 
always  a  certain  amount  of  the  metal  left.  Cor- 
rosion is  said  to  be  good  when  70  to  75  per  cent, 
of  the  metallic  lead  has  been  converted  into  the 
carbonate.  From  every  hundredweight  of  metallic 
lead  used,  50  to  78  pounds  of  white  lead  are  ob- 
tained. There  is  usually  a  trace  of  acetate  of  lead 
left  between  the  metal  and  the  superjacent  car- 
bonate. Occasionally  the  white  lead  shows  a 
delicate  pink  colour  from  the  tan.  Manufacturers 
prefer  a  hard — that  is,  a  crisp — corrosion  to  a 
soft  one. 

In  most  of  the  large  white  -  lead  •  producing 
countries,  men  only  are  allowed  to  strip  or  empty 


MANUFACTURE  OF  WHITE  LEAD  27 

a  white  bed  ;  for  it  is  dusty  work,  calling  for  water- 
spraying  and  for  the  wearing  of  respirators  on 
the  part  of  the  men.  The  hands  of  the  workmen 
become  covered  with  white  lead ;  the  fine  powder 
adheres  to  the  skin,  particularly  to  the  sides  of 
the  nails ;  it  also  penetrates  under  the  free  end 
of  the  nails.  The  dust,  too,  lodges  between  the 
hairs  of  the  beard  and  the  moustache.  From  the 
respirators  worn  by  the  men  considerable  quan- 
tities of  lead  can  be  recovered.  Emptying  of  a 
white  bed  is  hard  work.  The  material  is  carried 
away  in  wooden  boxes  by  the  men,  or  swung  out 
of  the  stacks  by  means  of  machinery,  and  con- 
veyed to  the  wash-tubs  to  be  crushed  between 
wet  rollers  and  washed,  so  as  to  have  any  lead 
acetate  removed.  The  washed  white  lead  forms 
a  pulp.  This,  when  thoroughly  sedimented  and 
dried  in  an  oven,  is  sold  as  white  lead,  or  it  may 
be  straightway  mixed  with  linseed-oil  and  made 
into  paint.  One  of  the  most  dangerous  operations 
in  the  manufacture  of  white  lead  is  emptying  the 
ovens  or  stoves.  Formerly  emptying  of  the  stoves 
by  hand  labour  gave  rise  to  more  cases  of  serious 
plumbism  than  any  other  process.  By  substi- 
tuting machine  for  hand  labour,  much  sickness 
has  been  averted.  The  other  method  of  dealing 
with  the  sedimented  white  lead  is,  as  stated,  to 
treat  it   at  once  with   linseed-oil  by  the  method 


28  LEAD  POISONING 

known  in  the  trade  as  "  pulping."  When  I  was 
a  member  of  the  Potteries  Commission  of  the 
Home  Office,  my  attention  was  drawn  to  this 
method  of  treating  the  washed  white  lead  by 
M.  Besancon,  during  my  visit  to  the  white  lead 
works  of  MM.  Besancon,  Expert  et  Cie.,  Paris. 
After  having  been  washed  and  the  excess  of  water 
removed  by  filter  presses,  the  white  lead  is  passed, 
through  a  series  of  rollers,  during  which  linseed- 
oil  is  constantly  being  added.  By  degrees  the  oil 
replaces  the  water  in  the  pulp,  so  that  from  the 
end  roller  a  practically  finished  paint  escapes,  yet 
one  not  quite  free  from  water.  The  remaining 
water  is  extracted  by  placing  the  material  in  a 
closed  iron  cylinder  heated  by  a  steam  jacket 
and  kept  under  a  reduced  pressure.  By  this 
means  nearly  all  the  water  is  removed,  only  part 
of  a  decimal  point  being  left.  Struck  by  the 
cleanliness  of  M.  Besancon's  factory,  the  absence 
of  dust,  and  the  freedom  of  the  men  from  lead 
poisoning,  I  reported  the  circumstance  to  the 
Home  Secretary  (then  Sir  Matthew  White  Ridley), 
who  at  once  circularized  the  British  manufacturers, 
with  the  result  that  the  firms  which  have  adopted 
the  process  mostly  sell  the  white  lead  in  the  form 
of  paint ;  but,  as  by  this  method  of  manufacture 
drying  chambers  or  ovens  have  been  abolished,  the 
factories  have  become  freer  from  lead  poisoning. 


MANUFACTURE  OF  WHITE  LEAD  29 

In  the  chamber  process  longer  and  thinner 
sheets  of  metallic  lead  are  used  than  in  the  Dutch 
process.  These  are  suspended  over  a  series  of 
rails  in  a  chamber,  and  the  door  is  hermetically 
closed.  Hot  acetic  acid  vapour  and  carbon 
dioxide  obtained  from  burning  coke  are  driven  into 
the  chamber  by  pipes  from  below.  Changes  of  a 
chemical  nature,  similar  to  those  described  as 
occurring  in  the  blue  bed  in  the  Dutch  process,  are 
induced ;  but  in  the  chamber  process  corrosion  is 
more  rapid,  for  in  fifty  to  sixty  days  the  metal  is 
converted  into  white  lead,  the  temperature  of  the 
chamber  having  been  kept  pretty  regularly  at 
about  6o°  C.  Before  opening  out  the  chamber, 
steam  is  injected  into  it  to  moisten  the  material 
and  to  render  it  less  dusty  to  the  men  when 
removing  it.  Before  the  men  enter  the  chamber 
the  door  is  kept  open  for  some  hours,  so  as  to 
allow  the  temperature  to  fall. 

In  this  country  there  has  been  an  outcry  against 
the  use  of  white  lead,  which  is  not  lessening, 
especially  since  France  has  passed  a  law  forbid- 
ding the  use  of  lead  for  decorative  purposes,  and 
which  comes  into  force  at  an  early  date  (1915). 
Considered  from  an  historical  point  of  view,  it  is 
hardly  likely  that  an  industry  which  has  been  in 
existence  for  more  than  2,000  years  will  readily 
disappear.     Trade  customs  die  hard.     Lead  com- 


30  LEAD  POISONING 

pounds  have  such  a  varied  and  extensive  field  of 
application  that  it  will  be  difficult  to  find  substi- 
tutes for  them  in  some  of  the  arts  and  manufac- 
tures. From  its  antiquity  alone  the  trade  is 
entitled  to  some  consideration,  even  while  we 
admit  that  lead  and  its  compounds  are  dangerous. 
Something  of  the  age  of  the  industry  may  be 
learned  from  an  address  given  by  C.  A.  Klein  *  to 
the  Paint  and  Varnish  Society,  London.  Cerussa 
as  a  cosmetic  is  alluded  to  by  Xenophon  (430- 
355  B.C.).  An  earthenware  box  belonging  to  this 
period  was  recently  unearthed,  and  found  to  con- 
tain a  mixture  of  white  lead  and  whiting.  This 
powder,  like  that  used  by  the  ladies  of  Florence  in 
the  fourteenth  century,  had  been  resorted  to  for 
the  purpose  of  heightening  beauty — a  practice 
apparently  not  without  danger,  since  it  drew  from 
Cennino  Cennini  a  warning  homily.  The  cerussa 
referred  to  by  Xenophon  was  probably  a  powder 
obtained  by  grinding  a  native  lead  carbonate  ore, 
such  as  is  still  known  as  cerussite.  According  to 
Vitruvius  (100  B.C.),  the  Rhodians  made  white  lead 
by  pouring  vinegar  into  vessels  over  vine  twigs 
contained  therein,  and  on  the  twigs  they  placed 
metallic  lead.  The  vessels  were  covered  over  to 
prevent  evaporation.     On  these  being  opened  after 

-*  Oil  and  Colour  Trades  Journal,  December  6  and  13, 
1913,  p.  1973,  etC- 


MANUFACTURE  OF  WHITE  LEAD  31 

a   specified   time,    the   lead    was   found  to   have 
become   converted   into    cerussa.      The    Rhodian 
product  was  regarded  as  an  article  of  great  com- 
mercial  value.     Considering   the    method   of  its 
preparation,  it  would  at  first  appear  as  if  the  sub- 
stance obtained  was  a  basic  acetate  of  lead,  and  not 
a  carbonate  ;  but  basic  acetate  of  lead  when  ex- 
posed to  atmospheric  air  becomes  gradually  con- 
verted into    carbonate.      A    certain    amount     of 
carbonic  acid  would,  however,  probably  be  present, 
since,   during  decomposition    of  the  twigs   upon 
which  the  lead  was  laid,  also  in  consequence  of 
decomposition  of  the  vinegrated  grape  pulp  likely 
to  occur  as  well,  carbonic  acid  would  be  evolved, 
and  would  assist  in  the  conversion  of  metallic  lead 
into  carbonate.     This  simple  method  of  convert- 
ing metallic  lead  into  carbonate  by  the  action  of 
acetic  acid  and  of  carbonic  acid  evolved  during 
fermentation  of  the  residuum  of  pressed  grapes  is 
still  followed  at  Klagenfurth,  in  Carinthia.     Cen- 
turies ago  the  heat-producing  agents  required  for 
the   conversion    of  metallic   lead   into  carbonate 
were  manure  and  other  decaying  organic  material. 
Not  only  is  heat  evolved  from  these,  but  carbonic 
acid  as  well.     In  order  to  increase  for  corroding 
purposes  the  carbonic  acid  given  off  from  manure, 
the  Dutch  in  1622  added  wine-lees  and  chalk  to 
vinegar.     They  also  improved  the  stack  process 


32  LEAD  POISONING 

then  in  existence,  and  became  active  competitors 
with  the  Venetians.  England  at  this  period  was 
awaking. 

In  1662  the  first  patent  was  granted  to  Eland, 
and  in  1749  Creed  obtained  a  patent  to  manufac- 
ture white  lead  by  what  is  now  known  as  the 
chamber  process.  At  this  date  not  only  was 
Newcastle-upon-Tyne  a  recognized  seat  of  the 
trade,  but  it  was  here  that  was  introduced  the  use 
of  spent  tan  bark  in  the  corroding  stacks,  and 
which  has  been  ever  since  an  important  element 
in  the  manufacture  of  white  lead  by  the  Dutch 
process.  The  patent  for  the  use  of  tan  bark  was 
granted  to  Richard  Fishwick,  then  a  partner  in  the 
now  well-known  firm  of  Messrs.  Walker,  Parker 
and  Co.,  Newcastle-upon-Tyne.  As  thus  modified, 
the  Dutch  process  has  still  many  adherents. 
Opinions  differ  as  to  the  relative  values  of  white 
lead  manufactured  by  the  Dutch  method  (fourteen 
weeks)  and  that  by  the  chamber  process  (eight 
weeks).  Regarded  from  the  hygienic  point  of  view, 
the  chamber  process  is  cleaner,  time  is  saved  in 
the  corrosion,  more  of  the  metal  is  said  to  be 
corroded,  and  there  is  a  saving  of  labour  in  filling 
and  emptying  the  chambers.  Mr.  Noel  Heaton  * 
considers  chamber  white  lead  to  be  brighter  in 
colour,  probably  owing  to  the  absence  of  tan 
*  Journal  of  the  Royal  Society  of  Arts,  March  14,  1913- 


MANUFACTURE  OF  WHITE  LEAD 


33 


influence,  to  be  finer  in  the  grain  and  more 
uniform,  but  many  master-painters  with  whom  I 
have  discussed  the  question  prefer  white  lead  made 
by  the  Dutch  process.  That  the  material  thus 
produced  must  possess  the  good  qualities  ascribed 
by  them  to  it  is  shown  by  the  fact  that  the  Dutch 
process  still  remains  in  many  factories  the  sole 
method  of  making  white  lead.  Nay,  more  than 
this  :  of  the  275,000  tons  of  white  lead  produced 
by  various  processes,  the  approximate  quantities 
given  by  Klein  are — 


Stack,  i.e.,  Dutch,  process  .. 

Chamber 

Miscellaneous  


Tons. 

180,000 

45,000 

50,000 


In  Great  Britain  it  is  estimated  that  70  per  cent, 
of  the  white  lead  is  manufactured  by  the  Dutch 
process,  and  in  the  United  States  80  per  cent. 
Estimating  the  total  production  of  white  lead  in 
the  world  to  be  275,000  tons,  it  is  interesting  to 
see  how  the  various  countries  contribute  to  it : 


United  States 

Great  Britain 

Germany 

France 

Belgium 

Russia 

Italy   ... 

Holland 

Spain  ... 

Canada 


English  Tons 

Dry. 
.     120,000 

•  55.ooo 

•  36,500 
20,000 
15,000 
14,500 

4.500 
2,500 
2,500 
2,500 

3 


34 


LEAD  POISONING 


Statistics  of  Industrial  Lead  Poisoning 

In  the  Annual  Report  of  the  Chief  Inspector  of 
Factories,  1912,  Dr.  T.  M.  Legge  has  presented  in 
tabular  form  the  number  of  cases  of  lead  poisoning 
notified  to  the  Home  Office  for  thirteen  years — 
1900  to  1912  inclusive.  Compulsory  notification 
of  cases  of  industrial  lead  poisoning  has  proved  of 
invaluable  service,  not  only  in  supplying  informa- 
tion to  the  Home  Office  of  the  presence  of 
plumbism  in  a  particular  factory,  but  of  drawing 
attention  to  the  possible  existence  of  defects, 
structural  or  otherwise,  and  of  the  necessity  of 
immediately  remedying  them.  In  white  lead 
factories  alone  the  deaths  were  as  follows : 


Year. 

Cases. 

Deaths. 

1  goo 

358 

6 

1901 

189 

7 

1902 

143 

1 

1903 

109 

2 

1904 

116 

2 

!905 

90 

0 

1906 

108 

7 

1907 

7i 

0 

1908 

79 

3 

1909 

32 

2 

1910 

34 

1 

1911 

41 

2 

1912 

23 

0 

Total 

i>393 

33 

INDUSTRIAL  LEAD  POISONING 


35 


That  is,  of  those  suffering  from  plumbism  2'2  per 
cent.  died. 

As  showing  the  difference  in  the  mortality  rates 
of  lead  poisoning  due  to  working  in  white  lead 
factories  and  lead  poisoning  following  upon  work- 
ing in  other  trades  in  which  white  lead  is  used,  the 
following  table,  taken  from  the  same  source,  will 
not  be  out  of  place  : 

All  Cases  of  Industrial  Lead  Poisoning  notified  to 
Home  Office,  with  Number  of  Deaths. 


Year. 

Cases. 

Deaths. 

1900 

1,058 

38 

1901 

863 

34 

1902 

629 

H 

1903 

614 

*9 

1904 

597 

26 

I9°5 

592 

23 

1906 

632 

33 

1907 

578 

26 

1908 

646 

32 

1909 

553 

30 

1910 

505 

38 

1911 

669 

37 

1912 

587 

44 

Total 

8,523 

394 

Taking  the  total  cases  of  lead  poisoning,  the 
fatal  cases  are  4*5  per  cent. ;  but  if  we  deduct  the 
cases  and  deaths  of  lead  workers,  the  mortality 
rate  is    5*06,    as   against  the  2*2  per  cent,    fatal 


36  LEAD  POISONING 

cases  in  white  lead  workers.  This  difference  in 
the  mortality  rate  is  not  without  significance;  it 
suggests  that  it  is  among  white  lead  workers  that 
the  regulations  issued  and  enforced  by  the  Home 
Office  have  been  most  productive  of  good. 

The  8,523  cases  of  lead  poisoning  occurred 
among  persons  employed  in  eighteen  industries. 
The  number  of  cases  notified  in  1900  and  1901 
were  respectively  1,058  and  863,  and  for  1911 
and  19 12  they  were  669  and  587.  While  the 
number  of  cases  notified  has  declined,  the  same 
cannot  be  said  of  the  fatalities.  In  1900  and 
1901  the  fatal  cases  were  38  and  34  respectively, 
but  in  1911  and  1912,  although,  according  to  the 
tables,    fewer   cases   were    reported,    there   were 

37  and  44  deaths  respectively. 

Control  of  dust  in  industrial  occupations  in 
which  white  lead  and  lead  compounds  are  manu- 
factured or  handled  has  done  much  to  bring 
about  a  reduction  in  the  number  of  cases  of 
plumbism.  It  is  Dr.  Legge's  opinion  that,  if  the 
amount  of  lead  present  in  the  air  breathed  is  less 
than  5  milligrammes  per  10  cubic  metres  of  air, 
saturnine  encephalopathy  and  paralysis  will  not 
occur.  Taking  ten  hours  as  the  period  of  an 
ordinary  working  day,  it  is  estimated  that  during 
that  time  4!  cubic  metres  of  air  pass  in  and  out 
of  the  lungs.     The  inhalation  of  2  milligrammes 


INDUSTRIAL  LEAD  POISONING  37 

of  lead  daily  in  the  form  of  fume  or  dust  would  in 
the  course  of  a  year  set  up  lead  poisoning.  If 
such  an  amount  of  lead  reached  the  lung  in  each 
working  day,  something  like  600  milligrammes,  or 
10  grains,  of  lead  might  be  absorbed  in  the  course 
of  one  year ;  but  there  is  no  evidence  to  support 
this  mathematical  contention.  Dr.  Ludwig  Teleky 
of  Vienna  informs  us  that  a  daily  dose  of  a  little 
more  than  1  milligramme  of  lead  taken  for  several 
months  will  cause  plumbism,  and  that  a  daily  dose 
of  10  milligrammes  will  cause  symptoms  of  severe 
saturnine  intoxication  in  a  very  short  time.  We 
can,  of  course,  never  be  quite  sure  of  the  quantity 
of  lead  which  reaches  the  lungs  and  is  retained 
there  in  men  who  are  working  in,  and  breathing, 
an  atmosphere  laden  with  lead  dust,  for  much  of 
the  dust  is  caught  in  the  nasopharynx  and  is 
swallowed,  or  it  is  trapped  in  the  upper  respiratory 
passages  and  does  not  reach  the  lungs  at  all.    - 

The  results  of  the  notification  of  lead  poisoning 
are  extremely  interesting  as  showing  the  changes 
which  have  taken  place  both  in  the  personnel  of  the 
workers  and  in  the  hygiene  of  certain  trades.  In 
1900  the  largest  number  of  cases  of  plumbism 
occurred  in  the  white  lead  trade — viz.,  358,  with 
6  deaths  ;  in  earthenware  and  pottery  there  were 
200  cases  reported  and  8  deaths.  In  1912  the 
manufacture  of  white  lead  no  longer  occupies  the 


38  LEAD  POISONING 

unenviable  first  place  on  the  list  of  trades  in 
which  plumbism  occurs.  This  position  is  taken 
by  the  earthenware  and  pottery  industry,  with 
80  cases  and  14  deaths,  and  closely  upon  it 
comes  coach-building,  with  84  cases  and  7  deaths, 
as  against  70  cases  with  5  deaths  for  igoo,  or  an 
increase  of  i"2  per  cent.  Smelting  of  metals, 
which  in  1900  gave  34  cases  with  1  death,  gave  in 
1912  56  cases  with  7  deaths;  printing,  with 
18  cases  and  2  deaths  in  1900,  furnished  in  1912 
37  cases  without  a  death.  On  the  other  hand, 
the  manufacture  of  white  lead,  which  was  formerly 
regarded  as  one  of  the  most  dangerous  of  all  the 
lead  industries,  with  its  358  cases  and  6  deaths  in 
1900,  gave  in  1912,  with  no  deaths  recorded 
against  it,  23  cases.  These  figures  refer  only  to 
plumbism  occurring  in  persons  mostly  at  work  ; 
they  convey  no  intimation  of  the  number  of 
deaths  caused  by  kidney  and  other  internal 
diseases,  and  which  are  consequences  of  chronic 
plumbism  in  persons  many  of  whom  had  years 
previously  worked  in  lead  factories. 

The  undesirable  position  occupied  by  coach  and 
house  painting  on  the  list  of  occupations  in  which 
plumbism  occurs  is  not  confined  to  Great  Britain 
alone.  On  the  Continent  the  same  event  is 
taking  place.  The  rapid  rise  of  the  motor-car 
industry  is  largely  responsible  for  the  increase  in 
the  number  of  cases  notified.     Lead  poisoning  is 


INDUSTRIAL  LEAD  POISONING  39 

more  prevalent  among  house  painters  than  it 
ought  to  be.  Painters  when  at  work  are  not 
always  strictly  observant  of  details  of  personal 
hygiene.  The  practice  of  holding  the  brush  be- 
tween the  teeth,  of  holding  putty,  which  is  a  lead 
product,  in  the  palm  of  the  hand,  of  not  always 
having  the  opportunity  of  washing  before  eating, 
or  of  misusing  the  opportunity  when  it  exists, 
predisposes  them  to  plumbism.  Inhalation  of 
dust  given  off  during  the  sand-papering  of  dried 
painted  surfaces,  also  of  the  fumes  given  off  during 
the  burning  off  of  old  paint,  are  sources  of  lead 
poisoning.  The  clothes  worn  by  the  men  become 
stained  with  paint.  I  have  treated  women  who 
had  washed  the  overalls  of  their  menfolk,  who 
were  house  painters,  for  double  wrist-drop,  and  in 
the  water  removed  from  the  wash-tubs  I  found 
large  quantities  of  lead.  In  these  cases  the 
poison  either  was  absorbed  through  the  skin  by 
friction  during  the  act  of  washing,  was  inhaled  as 
dust  on  shaking  the  clothes  before  washing  them, 
or  was  inhaled  as  fine  particles  in  the  steam. 

People  have  suffered  severely  in  health  through 
having  slept  in  newly-painted  rooms.  There  is 
an  account  in  the  textbooks  of  an  outbreak  of 
lead  colic  among  the  crew  of  a  freshly-painted 
French  man-of-war.  All  persons  are  not  equally 
susceptible  to  the  harmful  emanations  from  painted 
surfaces.     Some  people  cannot  be  exposed  to  the 


4o  LEAD  POISONING 

odour   of  paint   without    experiencing    headache 
followed  by  retching  and  vomiting. 

It  would  be  interesting  to  know  precisely  what 
are  the  harmful  emanations  given  off  from  a 
painted  surface.  Professor  C.  Baly,  of  Liver- 
pool, found,  on  spectroscopic  examination  of  the 
air  drawn  from  over  newly  -  painted  surfaces, 
evidence  of  the  presence  of  lead ;  but  a  further 
series  of  experiments  led  him  to  alter  this  state- 
ment, and  to  attribute  the  influence  for  harm  to 
"  unsaturated  aldehydes,"  or  the  volatile  emana- 
tions given  off  by  certain  lead  paints.  Taking  the 
two  substances,  white  lead  and  sulphate  of  lead, 
and  mixing  them  separately  with  linseed-oil  in 
exactly  the  same  manner,  he  noticed  that  there 
was  a  difference  in  the  odour  evolved.  When  the 
emanations  from  the  white  lead  surface  were 
examined  by  the  spectroscope,  they  were  found 
to  contain  a  substance  which  absorbed  ultra- 
violet radiations  given  off  at  a  temperature  of  6o° 
to  650  C.  Sulphate  of  lead  mixed  with  linseed- 
oil  did  not  give  exactly  the  same  results  as  the 
carbonate,  while  dry  white  lead  gave  a  negative 
result.  It  is  maintained  that  if,  in  the  emanations 
there  is  present  a  sufficiency  of  "  unsaturated 
aldehyde,"  not  only  is  the  odour  nauseating,  but 
it  causes  a  sense  of  tiredness  attended  by  headache 
and  followed  by  diarrhoea,  symptoms  suggestive 


INDUSTRIAL  LEAD  POISONING  41 

of  some  form  of  intoxication.  Baly  did  not  find 
evidence  of  lead  in  the  emanations  in  the  second 
series  of  experiments,  but  of  "unsaturated  alde- 
hydes," or  substances  given  off  more  readily  by 
the  hydroxide  of  lead  than  by  the  carbonate,  also 
by  other  oxides  of  lead  and  binoxide  of  manganese. 
At  ordinary  temperatures  the  volatile  substance  is 
given  off  in  the  following  proportions  : 

Zinc  white  and  basic  sulphate  of  lead  ...       1 

White  lead  15 

Lead  hydroxide    ...         ...         ...         ...         ...     25 

The  symptoms  alluded  to  as  occurring  in 
persons  who  inhale  the  emanations  from  freshly- 
painted  surfaces  are  therefore  by  Baly  believed  to 
be  caused  by  aldehyde  compounds,  and  not  by 
lead.  He  is  of  the  opinion  that  the  cause  for 
harm  would  greatly  disappear  if  zinc  white  or 
basic  sulphate  of  lead  was  used  instead  of  white 
lead  or  minium,  but  in  all  cases  it  is  necessary  to 
reduce  to  the  smallest  quantity  possible  the 
amount  of  "  dryer  "  employed,  for  the  addition  of 
turpentine  to  the  paint  increases  the  amount  of 
aldehyde.  Baly  thinks  that  the  rapidity  with 
which  the  symptoms  develop  is  rather,  but  not 
absolutely,  against  lead  poisoning. 

Professor  H.  E.  Armstrong  and  Mr.  C.  A. 
Klein*   take   the   view    that    the    production    of 

*  Society  of  Chemical  Industry,  "  The  Behaviour  of 
Paint  under  the  Conditions  of  Practice,"  February  3,  1913. 


42  LEAD  POISONING 

volatile  products  is  not  peculiar  to  white  lead,  but 
is  common  to  all  drying  agents.  According  to 
them,  no  lead  is  found  in  the  vapour  given  off  by 
paints  during  drying.  The  vapours  consist  of 
"  volatile  thinners  "  and  oxidation  products  of  the 
oil  which  are  common  to  all  paints.  The 
products  of  oil-drying  are  absolutely  harmless, 
but  the  vapours  arising  from  the  turpentine  are 
responsible,  they  believe,  for  the  toxic  effects 
observed  in  persons  who  have  slept  in  recently- 
painted  rooms.  The  effects  would  thus  be  in  no 
way  due  to  lead,  since  they  might  be  produced  by 
all  paints  which  contain  turpentine. 

As  to  what  the  emanations  from  freshly-painted 
surfaces  really  are,  it  is  apparent  that  the  last 
word  has  not  been  said.  Chemical  experiment 
and  medical  experience  can  alone  solve  the 
problem.  Air  withdrawn  from  a  bell-jar  in  which 
metal  boxes  recently  painted  with  white  lead  had 
been  placed,  when  passed  through  a  10  per  cent, 
solution  of  sulphuric  acid,  was  found  to  contain 
lead.  There  may  be  other  harmful  substances 
present  in  paint  than  lead.  Messrs.  Heim  and 
Hebert  exposed  moulds,  especially  Penicilium 
glaacutn,  to  air  in  closed  bell-jars  under  the 
following  conditions :  (a)  Air  alone ;  (6)  air 
which  might  have  been  infected  with  lead ; 
and  (c)  air  in  contact  with  fresh  paint.  In 
(a)    the    moulds    developed    by    the   third    day ; 


INDUSTRIAL  LEAD  POISONING  43 

in    (b)   shortly    after    the    third    day ;     while    in 
(c)    not    only   was   there    considerable    delay   in 
development,  but   the   colonies  which  developed 
were    few.      Another    mould,    Aspergillus    niger, 
had    its    growth    similarly   arrested.     These    ex- 
periments   do    not    prove    that    lead    was    the 
harmful  agent.     Trillat  did  not  find  that   white 
lead  or  oil,  singly  or  combined,  checked  vegetable 
growth,    but  that  freshly-mixed  paint  containing 
turpentine  in  addition  had  the  power  of  doing  so. 
A  guinea-pig  exposed  in  a  bell-jar  to  air   drawn 
over  a  newly-painted  surface  died  within  eighteen 
hours  from  acute  congestion  of  the  lungs,  but  the 
death    was    probably    the     result     of    breathing 
terebinthinated  vapour;    for   in    one  of   my  own 
experiments  a  mouse  which  had  only  been  once 
for  two  hours  in  a  large  bell-jar,  through  which 
turpentine  vapour  was   passed,    died  three   days 
afterwards  from  acute  pulmonary  congestion  and 
minute  haemorrhages.    To  some  persons  turpen- 
tine  is   a  rank  poison  ;    it  causes   headache  and 
vomiting.    And  yet  turpentine  alone  can  hardly  be 
the  cause  of  all  the  symptoms  observed  in  persons 
who    have    been    sleeping    or    living    in    newly- 
painted  rooms,  for  Trillat  found  that,  if  the  paint 
was  made  with  zinc  white  instead  of  lead  carbon- 
ate, even  although  it  contained  the  same  amount 
of    turpentine,    no    symptoms    developed.     This 
would  suggest  that  there  is  something  of  a  harmful 


44  LEAD  POISONING 

nature  developed  when  white  lead,  linseed-oil,  and 
turpentine,  are  mixed  together.  Trillat's  obser- 
vations await  confirmation.  I  have  had  to 
treat  men  who,  after  mixing  white  lead  with 
certain  oils,  suffered  severely  from  headache, 
retching,  and  vomiting,  and  not  when  other  oils 
were  used,  but  the  symptoms  developed  were  not 
those  of  lead  poisoning.  They  suggested  poisoning 
of  another  type  than  that  caused  by  lead.  I  have 
kept  animals  in  hutches  exposed  to  vapours  given 
off  from  newly-painted  surfaces  for  weeks  without 
symptoms  developing  ;  and  yet  I  recently  had  to 
treat  a  London  medical  practitioner  who  had 
lived  at  home  during  the  few  weeks  the  interior  of 
his  house  was  being  painted,  and  who  had  not 
only  suffered  from  severe  colic,  but  developed 
albuminuria  and  profound  anaemia.  As  lead  was 
found  in  his  urine,  the  diagnosis  was  plumbism, 
but  a  doubtful  point  subsequently  arose  as  to 
the  source  of  the  plumbism,  for  when  ill  the 
patient  had  gone  to  a  small  Yorkshire  town  the 
drinking  water  of  which  had  been  contaminated  by 
lead. 

Henry  A.  Gardner,*  assistant  director,  the  Insti- 
tute of  Industrial  Research,  Washington,  U.S.A., 

*  "  The  Toxic  and  Antiseptic  Properties  of  Paints," 
Educational  Bureau,  Paint  Manufacturers'  Association  of 
the  United  States,  Bulletin  41,  19 14. 


INDUSTRIAL  LEAD  POISONING  45 

finds,  after  an  extended  research  into  the  character 
of  the  volatile  vapours  given  off  by  various  paint 
materials,  that,  as  paint  vapours  do  not  contain 
metallic  ingredients,  they  cannot  be  held  account- 
able for  lead  poisoning.  The  most  important 
outcome  of  his  tests  is  the  discovery  of  carbon 
monoxide  in  the  vapours  of  drying  paints.  To 
inhalation  of  this  gas  Gardner  attributes  the 
anaemia  from  which  painters  suffer.  In  the  drying 
of  thin  layers  of  linseed-oil  there  is  an  absorption 
of  oxygen,  accompanied  by  the  evolution  of  carbon 
dioxide  and  carbon  monoxide.  A  small  quantity 
of  formic  acid  is  also  given  off.  The  amount  and 
character  of  the  volatile  substances  are  affected  by 
the  type  of  pigment  used.  Aldehydic  substances 
are  also  given  off  from  drying  oil  paints,  which 
have  a  bactericidal  effect  upon  pathogenic 
bacteria,  a  point  to  which  I  will  allude  farther  on. 
Gardner's  tests  were  carried  out  in  a  large  linoleum 
works  where  tons  of  linseed-oil  were  being  used. 
His  views  are  extremely  interesting,  and  give 
material  for  reflection,  for  as  medical  men  we 
wish  to  know  more  than  we  do  of  the  harmful 
effects  upon  workmen  of  the  repeated  inhalation  of 
minute  quantities  of  carbon  monoxide.  "  Symptoms 
such  as  sallow  complexion,  general  lassitude, 
emaciation,  and  inco-ordination,  caused  by  the 
inhalation  of  carbon  monoxide  over  long  periods 


46  LEAD  POISONING 

of  time,  might  be  mistaken  for  symptoms  of  lead 
poisoning."  It  is  to  be  remembered  that  it  is, 
with  painters,  not  so  much  the  putting  on  of 
fresh  paint  which  is  the  cause  of  symptoms,  as  the 
chipping  off  of  old  and  dried  paints.  Gardner's 
researches  have  struck  a  new  line,  and  on  that 
account  are  interesting  and  valuable. 

They  seemed  to  me  to  be  so  valuable  that  I 
exposed  a  guinea-pig  to  the  vapour  given  off  by  a 
leadless  paint,  and  another  guinea-pig  to  vapour 
from  a  lead  paint.  Although  at  the  end  of  five 
hours  the  first  animal  seemed  uncomfortable, 
shortly  after  it  was  removed  from  the  bell-jar,  and 
placed  on  the  laboratory  floor,  it  was  soon  all 
right  again.  The  experiment  was  repeated  for 
three  days — six  hours'  exposure  each  day — without 
any  bad  effects.  The  other  animal,  which  was 
exposed  to  the  vapours  from  lead  paint,  at  the  end 
of  three  hours  seemed  uncomfortable.  Its  move- 
ments were  inco-ordinated,  and  there  was  marked 
polyuria.  The  animal  staggered  if  it  attempted 
to  walk,  or  it  kept  rolling  over  and  over,  trying 
to  regain  its  feet.  Next  day  the  animal  was  found 
dead.  The  signs  enumerated  were  not  those  of 
lead  poisoning.  On  examining  the  blood  removed 
from  the  heart,  carbon  monoxide  was  found  by  one 
of  my  colleagues  and  myself. 

There   appeared   recently  in  the   daily   papers 


INDUSTRIAL  LEAD  POISONING  47 

the  details  of  an  inquiry  into  the  death  of  an 
infant,  two  years  old,  in  the  workhouse  at  Bath. 
This  occurred  during  the  painting  of  a  corridor, 
which  continued  for  five  days.  The  finding  was 
"  Death  from  lead  poisoning."  Two  other 
children  and  one  woman  had  also  been  ill. 
The  paint  was  said  to  contain  10  pounds  of 
white  lead  in  12  pounds'  weight  of  paint.  The 
corridors  had  frequently  been  painted  before 
without  any  mishap.  There  is  no  evidence  that 
in  this  case  death  was  due  to  plumbism.  Much 
more  likely  it  was  the  result  of  inhalation 
of  vapours  given  off  during  drying  of  the  oil. 
Linseed-oil  in  drying,  as  we  have  already  seen, 
increases  in  weight,  owing  to  absorption  of  oxy- 
gen. Various  decomposition  products  are  formed, 
amongst  which  may  be  mentioned  formic  acid, 
acetic  acid,  carbon  dioxide,  carbon  monoxide,  and 
aldehydes,  but  as  to  which  of  these  is  the  agent 
for  harm,  it  is  impossible  to  say.  All  we  can  say 
is  that  carbon  monoxide  is  possible. 

Some  of  the  dryers  which  are  added  to  paints 
are  more  harmful  than  others.  In  my  laboratory 
a  rat  exposed  for  a  few  hours  daily  to  the  vapour 
given  off  from  a  spirit  containing  benzole  ex- 
perienced no  inconvenience,  but  exposure  of  the 
animal  under  similar  conditions  to  a  spirit  con- 
taining turpentine,  used  by  a  local  firm  of  paint 


43  LEAD  POISONING 

manufacturers  for  mixing  paints  killed  it,  death 
being  due  to  pulmonary  congestion.  Turpentine 
is  a  reducing  agent :  it  absorbs  oxygen  so  as  to 
form  with  it  a  resinous  body ;  this  combination  is 
hastened  in  the  presence  of  lead  oxide.  According 
to  Von  Jaksch,*  the  symptoms  complained  of  by 
men  after  working  in  an  atmosphere  impregnated 
with  turpentine  are  headache,  dizziness,  dry 
throat,  cough,  bronchitis,  strangury,  and  the 
presence  of  blood  in  the  urine.  As  the  kidneys 
are  the  main  organs  by  which  turpentine  is 
eliminated  from  the  body,  pain  in  the  back  is 
frequently  complained  of.  The  men  become 
nervous  and  excited,  their  gait  is  staggering.  Drs. 
E.  R.  Hayhurst  and  T.  E.  Flynn,  along  with 
Mr.  R.  H.  Nicolls,t  made  a  detailed  examination 
of  sixty-two  painters  and  varnishers  in  Chicago. 
All  but  fifteen  of  the  men  had  worked  more  than 
ten  years.  Nearly  all  of  them  stated  that  after 
working  with  turpentine  they  became  drowsy, 
suffered  from  headache,  had  nausea,  vomiting, 
loss  of  appetite,  and  dizziness.  Minor  forms  of 
bladder  trouble,  of  inflammation  of  the  eyes  and 
of  the  skin,  were  common.  In  fourteen  of  the  men 
— i.e.,   31  "8    per   cent. — there   were    evidences   of 

*  "  Die  Vergiftungen,"  p.  405.     Wien  and  Leipzig,  1910. 
t  Report    of    Commission    on    Occupational    Diseases, 
State  of  Illinois,  1911. 


INDUSTRIAL  LEAD  POISONING  49 

organic  disease  of  the  kidneys,  while  an  equal 
number  of  them  complained  of  their  throat  and 
lungs. 

Dr.  Alice  Hamilton  is  of  the  opinion  that,  as 
ship-painters  have  to  carry  on  their  work  in  con- 
fined spaces,  symptoms  of  turpentine  poisoning 
occur  in  them  more  frequently  than  in  house- 
painters.  Setting  aside  the  classic  form  of  wrist- 
drop and  colic,  there  is  little  doubt  that  the  acute 
illness  house-painters  suffer  from  is  not  always 
plumbism,  but  is  the  result  of  the  inhalation  of 
vapours  given  off  by  the  materials  with  which 
the  pigments  are  mixed.  The  exact  nature  of 
these  vapours  is,  as  already  stated,  not  known. 
During  an  examination  of  100  painters  in  Chicago, 
February  to  April,  1913,  in  response  to  questions 
addressed  to  them  by  Dr.  Emery  R.  Hayhurst,  as 
to  what  the  men  themselves  considered  the  most 
unhealthy  part  of  their  occupation,  practically  all 
of  them  stated  that  they  were  rendered  temporarily 
sick  by  the  vapours  evolved  from  turpentine 
and  benzine.  Much  of  this  type  of  toxaemia  from 
which  the  men  suffer  is  the  result  of  the  increasing 
use  of  quickly-drying  paints.  In  addition  to 
turpentine,  petroleum  spirit  and  benzine  are  being 
used.  In  my  own  experiments  I  have  not  found 
benzine  spirit  so  quickly  harmful  to  animals  as 
turpentine.     This    may    have    been    due   to   the 

4 


50  LEAD  POISONING 

small  percentage  of  benzine  present.  Benzine 
causes  sleepiness.  Men  working  with  paint  con- 
taining it  complain  of  headache,  noises  in  the 
ears,  and  dizziness  ;  they  stagger  as  if  intoxicated, 
they  have  lapses  of  memory  and  hallucinations  of 
sight  and  hearing.  A  painter  thus  poisoned  by 
benzine  vapour  feels  like  a  man  who  has  been 
intoxicated  overnight  by  alcohol.  Where  men  are 
working  in  the  close  spaces  of  ships,  and  no  air  is 
circulating,  the  symptoms  of  poisoning  may  become 
alarming.  Currents  of  air  are  intentionally  excluded 
because  drying  takes  place  more  quickly.  The  men 
under  these  circumstances  may  be  found  by  their 
mates  in  a  state  of  collapse  or  of  unconsciousness ; 
they  maybe  breathing  heavily,  and  their  pulse  rapid. 
They  should  be  carried  into  the  open  air  at  once. 
Prolonged  exposure  to  vapour  containing  minute 
quantities  of  these  varieties  of  petroleum  spirit  is 
followed  by  impaired  digestion,  tremor,  nervous- 
ness, muscular  weakness,  chronic  bronchitis,  and 
defective  memory,  symptoms  indicating  that  the 
poisonous  vapours  have  a  special  affinity  for  nerve 
tissue.  Von  Jaksch  found  certain  forms  of  chronic 
skin  troubles  in  painters  using  pigment  mixed  with 
benzine. 

Clearly,  therefore,  turpentine,  petroleum  spirit, 
and  benzine,  when  used  as  dryers  of  paints,  give 
rise,  each  of  them,  to  a  series  of  symptoms  sui 


INDUSTRIAL  LEAD  POISONING  51 

generis.  Benzole,  which  is  occasionally  used  for 
removing  paint  and  varnish,  is  a  volatile  liquid  con- 
taining several  hydrocarbons.  Although  it  contains 
only  40  per  cent,  of  benzine,  it  is  more  volatile  and 
more  dangerous  than  benzine  (Von  Jaksch).  In- 
halation of  benzole  or  benzine  vapour  may,  under 
certain  circumstances,  be  rapidly  fatal.  Beinhaaer 
found  that  it  caused  disintegration  of  the  red  blood- 
corpuscles,  haemorrhages  upon  mucous  membranes 
and  into  various  organs  which  presented  signs  of 
parenchymatous  degeneration.*  In  acute  benzole 
poisoning  the  symptoms  are  headache,  dizziness,  a 
flushed  face  followed  by  cyanosis,  nervous  excite- 
ment not  unlike  that  caused  by  alcohol,  also  hallu- 
cinations, delirium,  and  coma.  In  chronic  cases 
of  benzole  or  benzine  poisoning  the  gums  and  lips 
become  inflamed  and  ulcerated ;  the  condition  of 
the  gums  recalls  that  observed  in  scurvy. 

The  peculiar  train  of  symptoms  observed  in 
persons  who  have  been  exposed  to  emanations 
from  newly-painted  surfaces,  and  which  are  not 
always  those  of  lead  poisoning,  must  be  my  excuse 
for  this  rather  long  digression.  Reverting  to  the 
subject  of  plumbism  in  house-painters,  the  men 
who  suffer  most  are  those  who  mix  the  colours, 

*  "  Hygiene  of  the  Painters'  Trade,"  Bulletin  of  the  U.S. 
Bureau  of  Labour  Statistics,  Dr.  Alice  Hamilton,  May  13, 
i9J3- 


52  LEAD  POISONING 

also  those  who  use  them.  House-painters  prob- 
ably become  ill  less  frequently  through  inhaling 
vapour  than  from  breathing  the  dust  given  off 
during  sand-papering  of  flat  surfaces  or  during 
the  smoothing  of  these  with  pumice-stone.  In 
1907,  during  a  Government  inquiry  in  Austria, 
208  painters  were  examined  in  a  particular  district. 
Fifty  of  the  men  gave  a  history  of  lead  poison- 
ing; of  these,  23  stated  that  their  first  attack  of 
plumbism  developed  after  dry  sand-papering  lead- 
painted  surfaces.  Of  100  painters  examined  by 
E.  R.  Hayhurst  in  Chicago,  99  complained  of 
the  lead  paint  dust  given  off  during  sand-papering, 
and  of  these  men  27  had  had  genuine  attacks  of 
plumbism. 

The  use  of  water  with  pumice-stone  allays  dust. 
Moistening  the  sand-paper  with  oil  in  no  way 
interferes  with  the  results  from  a  decorative,  and 
is  of  assistance  from  a  health,  point  of  view.  Old 
painted  surfaces  have  to  be  prepared  for  fresh 
coatings  by  being  burnt  off,  by  chipping  and 
sand-papering.  The  flame  from  a  gasoline  lamp 
causes  the  paint  to  shrivel  and  to  curl  up.  Men 
when  doing  this  particular  kind  of  work  have 
complained  of  feeling  ill,  but  it  is  a  question  as 
to  how  far  the  symptoms  are  those  of  plumbism. 
The  odours  evolved  during  the  burning  off  of  old 
paint   are  anything   but  agreeable.      They  cause 


INDUSTRIAL  LEAD  POISONING  $3 

headache  and  sickness.  Does  the  stithe  which  is 
given  off  contain  lead  ?  Professor  Julius  Stieg- 
litz,*  of  the  Chemical  Department  of  the  Univer- 
sity of  Chicago,  hardly  thinks  it  is  possible  for 
lead  to  be  given  off  by  the  painted  surface  during 
the  short  time  the  gasoline  flame  is  in  contact 
with  it.  The  temperature  is  not  high  enough. 
If,  on  the  other  hand,  the  flame  is  allowed  to  play 
long  enough  upon  the  painted  surface,  and  smoke 
should  rise,  the  smoke  is  capable  of  carrying  away 
mechanically  lead  particles  with  it.  Such  symp- 
toms as  headache,  retching,  and  a  feeling  of 
malaise,  therefore,  would  probably  be  under 
ordinary  conditions  the  result  of  the  overheated 
oil  of  the  old  paint  rather  than  the  result  of  lead 
intoxication ;  but  whether  it  be  this  or  not,  it  is 
desirable  that  after  every  hour  or  two  of  work  done 
the  burnt-off  paint  which  has  fallen  to  the  ground 
should  be  swept,  gathered,  and  removed,  before  it 
has  had  time  to  become  dried  and  pulverized. 

House-painters  employed  on  internal  decorative 
work  are,  when  compared  with  outside  men,  more 
exposed  to  the  vapours  from  recently-painted 
surfaces,  also  to  the  dust  from  dried  paint.  More 
sand  -  papering  is  done  inside  than  outside  our 
houses.      There  is   a  growing  demand  in  Great 

*  Bulletin  of  the  U.S.  Bureau  of  Labour  Statistics,  1913.. 
P-  35- 


54  LEAD  POISONING 

Britain  for  zinc  white  and  lithopone  for  internal 
decoration.  In  the  United  States  the  painting 
of  signboards  is  a  special  trade.  It  is  highly 
skilled  labour.  Young  men  are  apprenticed  to 
the  trade  for  four  years.  During  the  last  fifteen 
years  a  change  has  been  creeping  over  this  trade. 
"  Signboards  "  are  now  prepared  in  the  painters' 
shops.  Lead  is  one  of  the  commonest  pigments 
used  both  on  iron  and  wood.  Although  the  occu- 
pation is  not  so  healthy  as  it  was  when  all  the 
work  was  carried  on  out  of  doors,  yet,  since  sand- 
papering is  not  required  to  any  extent,  the  work 
is  much  healthier  than  that  of  a  house-painter. 

Ship-painting,  so  far  as  the  decoration  of 
saloons  and  cabins  is  concerned,  is  highly  skilled 
work.  As  in  coach-painting,  several  coats  of  paint 
have  to  be  applied.  The  paint  frequently  contains 
lead  and  turpentine,  and  when  the  surface  is  dry 
it  has  to  be  sand-papered.  Apart  from  the  use  of 
rapidly-drying  spirit  paints,  there  is  little  danger 
to  men  when  painting  the  outside  of  a  ship,  for 
the  work  is  carried  on  in  the  open  air,  so  that 
vapours  are  readily  dispersed.  It  is  the  inside 
work  which  is  trying  to  the  men,  for  when  the 
final  coats  are  reached  the  paint  frequently  con- 
tains lead  and  zinc  white  in  equal  parts,  with 
turpentine  only  and  no  linseed-oil.  This  is  the 
part  of  the  work  the  men  object  to ;  but,  as  stated 


LEAD  PAINTS  AND  LEADLESS  PAINTS       55 

earlier,  the  symptoms  are  probably  due  more 
to  turpentine  than  to  lead,  judging  from  the 
strangury,  hsematuria,  and  pain  in  the  back,  com- 
plained of.  The  remarks  apropos  of  the  finer 
decorative  work  inside  houses  and  ships  apply 
equally  to  the  painting  of  railway  carriages, 
coaches,  and  automobiles.  Painters  of  agricultural 
implements  occasionally  suffer  from  plumbism 
when  the  red  paint  contains  lead,  but,  as  much 
of  the  work  is  carried  on  in  the  open  air,  there  is 
less  risk  to  the  men  than  in  indoor  painting. 

Lead  Paints  and  Leadless  Paints 

We  can  hardly  avoid  considering  the  question 
of  lead  versus  leadless  paints.  Any  reliable  opinion 
upon  the  relative  commercial  and  decorative 
values  of  white  lead  paint  and  paint  made  with 
zinc  oxide  can  only  be  furnished  by  technical 
chemists,  colour  manufacturers,  master-decorators, 
and  practical  house  and  ship  painters.  Among 
these  experts  there  is,  unfortunately,  a  great  variety 
of  opinion.  Their  divergent  views  render  it  diffi- 
cult for  other  people  to  express  an  opinion.  The 
question  as  to  whether,  from  a  purely  decorative 
point  of  view,  the  use  of  white  lead  paints  should 
be  entirely  disallowed  is  a  matter  in  regard  to 
which  in  this  country  no  satisfactory  decision  has 
as  yet  been  arrived  at.     It  is  therefore  one  con- 


56  LEAD  POISONING 

cerning  which,  before  any  legislation  is  attempted, 
a  body  of  experts  should  be  invited  by  the  British 
Government  to  carry  out  a  series  of  experiments 
in  different  parts  of  the  country,  and  to  report 
to  the  Home  Office.  There  is  no  need  for  undue 
haste  in  the  matter.  France  has  passed  a  law 
totally  prohibiting  the  use  of  lead  paints  after 
1915,  but  doubts  have  been  expressed  both  in 
France  and  in  other  countries  as  to  the  wisdom 
of  the  step.  I  have  already  alluded  to  the  antiquity 
of  the  white  lead  industry,  and  to  the  difficulty 
of  abolishing  old  trade  customs.  These  remarks 
apply  here  equally  well.  Total  prohibition  of  the 
use  of  lead  paints  was  tried  in  Switzerland  in 
1904,  and  abandoned  as  being  impracticable.  The 
White  Lead  Commission  of  the  Netherlands 
reported  that  zinc  white  paints  withstand  the 
action  of  sulphuretted  hydrogen  better  than  white 
lead  paints,  but  that  they  do  not  withstand  the 
action  of  the  sulphurous  acid  present  in  the 
atmosphere  so  well  as  paints  made  with  white 
lead — that  is  to  say,  for  internal  decoration  zinc 
white  is  as  good  as,  if  not  better  than,  white  lead, 
but  that  for  outside  work  white  lead  is  superior. 
Since  1909  Belgium  has  prohibited  the  sale  and 
use  of  dry  white  lead,  but  she  allows  the  sale  of 
this  material  mixed  and  ground  in  oil.  Germany 
permits  the  sale  of  white  lead  paint  already  mixed 


LEAD  PAINTS  AND  LEADLESS  PAINTS      57 

and  ready  for  use.  Austria  prohibits  the  use  of 
white  lead  for  the  interior  of  houses.  No  uniform 
international  attitude  has  as  yet  been  assumed  in 
regard  to  this  important  question.  It  is  one  to 
which  the  International  Association  of  Labour 
Legislation  is  giving  attention. 

There  is  nothing  to  support  the  statement 
which  is  current  in  some  quarters,  that  British 
house-painters  are  prejudiced  in  favour  of  lead 
paints.  Knowing  the  danger  incidental  to  their 
use,  they  have  nothing  to  gain  by  using  them  to 
the  exclusion  of  others.  Zinc  oxide  and  litho- 
pone,  the  latter  a  compound  of  zinc  sulphide  and 
barium  sulphate,  have  been  recommended  as 
substitutes  for  lead  carbonate.  As  pigments  these 
undoubtedly  possess  valuable  properties.  The 
high  degree  of  opacity  owned  by  white  lead,  the 
readiness  with  which  it  obliterates  uneven  sur- 
faces and  produces  a  dense  white  effect  with  very 
little  material,  render  it  difficult  for  it  to  be  re- 
placed by  substitutes.  For  external  decoration 
lead  carbonate  stands  exposure  to  the  weather 
well.  There  is  less  division  of  opinion  in  regard 
to  zinc  white  giving  equally  as  good  results  as 
lead  carbonate  in  internal  work.  Noel  Heaton 
maintains  that  zinc  white  has  neither  the 
fineness   nor   the   density  of  white   lead,  nor   is 


S3  LEAD  POISONING 

there  that  peculiar  influence  exerted  upon  oil  by 
it  whereby  the  absorption  of  oxygen  is  increased 
and  the  paint  caused  to  dry  quickly.  To  the 
circumstance  of  white  lead  being  a  basic  com- 
pound containing  two  molecules  of  normal  car- 
bonate of  lead  and  one  of  hydroxide  is  attributed 
the  power  it  possesses  of  combining  with  oil  to 
form  a  paint  capable  of  producing  a  smooth 
working  quality  in  the  brush  which  all  painters 
like.  It  is,  however,  one  of  the  advantages 
claimed  for  zinc  white  that  the  paint  made  from 
it  is  not  so  readily  discoloured  by  sulphuretted 
hydrogen  gas.  Instead  of  becoming  changed,  like 
lead  paint,  by  this  gas  into  a  black  sulphide,  it 
becomes  the  white  sulphide  of  zinc  which,  as 
already  stated,  is  one  of  the  constituents  of  litho- 
pone.  Judging  from  the  Report  of  the  Nether- 
lands Government  and  our  own  experience  at 
home,  it  is  not  the  sulphuretted  hydrogen  in  the 
air  of  our  large  towns  which  is  the  discolouring 
agent,  so  much  as  the  sulphurous  and  sulphuric 
acids  which  are  being  given  off  in  increasing 
quantities  into  the  atmosphere  owing  to  the 
larger  consumption  of  coal-gas  for  illuminating 
and  cooking  purposes.  Coal-gas  attacks  zinc 
white  more  readily  than  it  does  white  lead.  It  is 
said — and  this  is  a  point  to  which  we  shall  return 
— that  greater  skill  and  care  are  required  with  zinc 


LEAD  PAINTS  AND  LEA DL ESS  PAINTS       59 

than  lead  paints,  and  that  they  must  be  applied  in 
thin  layers.  Zinc  white  requires  from  16  to  20  per 
cent,  of  oil  to  grind  it  into  a  stiff  paste  with  a 
minimum  of  turpentine. 

Oxide  of  zinc  is  not  a  dryer  like  white  lead. 
Dr.  A.  P.  Laurie,*  of  the  Heriot-Watt  College, 
Edinburgh,  raises  on  this  point  an  important 
question  as  to  what  is  meant  by  "  drying."  As 
applied  to  water  the  term  means  loss  by  evapora- 
tion, but  as  regards  spirit  varnish  it  means 
evaporation  of  spirit  and  an  undissolved  resin  left 
behind.  In  the  drying  of  linseed-oil  the  oil 
absorbs  oxygen,  and  the  fatty  acid  of  the  oil 
becomes  converted  into  oxy-linoleic  acid,  which  is 
the  most  stable  form  linseed-oil  can  assume.  Raw 
linseed-oil  when  exposed  to  the  air  takes  days  to 
dry,  but  the  drying  process  can  be  hastened  by 
treating  the  oil  with  white  lead.  The  white  lead 
is  of  itself  a  drier,  so  that  of  two  surfaces  painted 
respectively  with  white  lead  and  zinc,  each  con- 
taining its  proper  proportion  of  oil  and  exposed 
to  the  air,  the  surface,  painted  with  white  lead 
dries  the  more  quickly.  Laurie  maintains,  not- 
withstanding the  fact  of  the  painted  surface  being 
thinner,  that  weight  for  weight  zinc  white  has  as 
good  covering  power  as  the  carbonate  of  lead. 
Cruickshank  Smith  gives  as  the  spreading  capacity 

*  "  The  Paint  Question,"  J.  Cruickshank  Smith,  1909. 


60  LEAD  POISONING 

in  square  yards  per  hundredweight  the  following  : 
Oxide  of  zinc,  870;  red  lead,  424;  white  lead, 
614  to  806;  the  prices  per  hundredweight  in 
shillings  being  46,  28,  and  28  to  32,  respectively ; 
and  the  estimated  numbers  of  tons  required  for 
painting  the  surfaces  in  twenty  years  being  4,  4, 
and  5  to  6. 

When  the  proposed  interdiction  of  lead  paints 
was  being  discussed  in  the  French  Legislative 
Assembly,  opinions  of  experts  upon  the  relative 
merits  of  zinc  and  lead  were  quoted.  It  was 
stated  that  the  naval  engineers  of  Rouen,  after 
three  years'  experience  of  both  pigments,  preferred 
zinc  to  lead,  since  the  white  colour  of  the  paint 
did  not  blacken  under  the  influence  of  sulphur. 
Equally  favourable  to  zinc  were  the  opinions  of 
the  naval  engineers  of  Bordeaux.  At  the  request 
of  the  French  Government,  experiments  dealing 
with  the  covering  and  enduring  power  of  the  two 
paints  were  carried  out  at  the  Annexe  of  the  Pas- 
teur Institute,  Paris.  A  Commission  nominated 
by  the  Society  of  Public  Medicine  and  of  Hygiene 
undertook  a  series  of  experiments  with  the  object 
of  comparing  surfaces  painted  with  zinc  and  lead 
bases.  The  Commission  was  composed  of  Dr.  L. 
Martin,  M.  Livache  (a  chemist),  and  M.  Vaillant 
(an  architect),  along  with  Messrs.  Mauger,  Wernet, 
and  Rigolet,  representing  the  building  trades  of 
Paris. 


LEAD  PAINTS  AND  LEAD  LESS  PAINTS      61 

In  1902,  under  the  supervision  of  this  Commis- 
sion, a  working  painter  applied  paints  containing 
zinc  and  lead  bases  to  similar  surfaces,  and  a 
few  months  afterwards  the  following  report  was 
published  :  (1)  The  colour  and  the  polish  of  zinc 
white  are  equal  to  those  of  white  lead ;  (2)  the 
covering  power  and  drying  are  practically  the 
same.  In  order  to  test  the  enduring  properties  of 
the  paints,  it  was  necessary  to  allow  atmospheric 
agents  to  exercise  their  destructive  influence  over 
a  longer  period.  It  was  therefore  arranged  to 
examine  the  painted  surfaces  a  year  afterwards. 

In  October,  1903,  the  Commission  reported 
that  there  was  no  appreciable  difference  between 
the  paintings  so  far  as  concerned  their  reaction  to 
atmospheric  influences,  and  that  both  for  internal 
and  external  painting  the  results  were  absolutely 
comparable. 

Since  1903  three  additional  examinations  of  the 
painted  surfaces  have  been  made — viz.,  on  Sep- 
tember 30,  1904,  October  11,  1905,  and  October 
31,  1906,  all  the  reports  of  which  confirm  the 
previous  statement. 

Zinc  sulphide  and  lithopone  are  also  spoken  of 
as  substitutes  for  lead  carbonate.  Lithopone  is 
obtained  by  the  double  decomposition  of  barium 
sulphide  and  zinc  sulphate.  The  precipitate  con- 
sists of  barium  sulphate  and  zinc  sulphide.     The 


62  LEAD  POISONING 

precipitate,  which  is  beautifully  white,  is  washed, 
dried,  ground,  and  mixed  with  oil  to  form  a  paste 
which  has  all  the  appearance  of  white  lead  paint. 
Lithopone  was  placed  upon  the  market  as  a 
substitute  for  white  lead.  Petit  says  that  it  has 
less  covering  power  than  lead,  owing  to  the  large 
quantity  of  barium  sulphate  it  contains  —  viz., 
67  per  cent. 

Applied  to  iron  surfaces,  the  zinc  sulphide  of 
the  lithopone  is  said  to  part  with  its  sulphur  to 
the  metal  and  to  form  iron  sulphide,  also  that, 
while  the  zinc  sulphide  mixes  readily  enough  with 
oil,  yet,  owing  to  a  process  of  vulcanization,  it  is 
liable  to  undergo  decomposition. 

Dr.  Ignace  Kaup  informs  us  that  the  master- 
decorators  of  Vienna  have  recently  been  substi- 
tuting zinc  white,  also  lithopone,  for  lead  car- 
bonate in  private  dwellings,  but  that  for  public 
buildings  white  lead  and  varnish  are  still  used. 
Only  recently  several  of  the  workmen  when  paint- 
ing a  large  Government  building  in  Vienna 
became  ill.  The  illness,  rightly  or  wrongly,  was 
attributed  to  plumbism.  Master-painters  both  at 
home  and  abroad  are  divided  in  their  opinions  as 
to  the  value  of  lithopone.  Some  hold  that  it  does 
not  retain  its  colour  well,  and  that  its  covering 
power  is  not  so  good  as  that  of  white  lead.  It  is 
said  to  be  all  right  on  plaster,  but  not  so  satisfac- 


LEAD  PAINTS  AND  LEADLESS  PAINTS       63 

tory  on  wood,  especially  if  the  wood  is  new. 
Lithopone  possesses  the  advantage  of  being  about 
4s.  per  hundredweight  cheaper  than  white  lead. 
In  some  of  the  Swiss  railway  carriage  works  only 
zinc  white  and  lithopone  are  used. 

It  is  hardly  necessary  to  discuss  at  length  the 
question  of  the  use  of  sulphate  of  lead  as  a  sub- 
stitute for  lead  carbonate.  From  a  paint  point  of 
view  both  have  about  equal  values.  Although  it 
has  hitherto  been  generally  believed  that  lead 
sulphate  is  less  soluble  in  the  juices  of  the 
alimentary  canal  than  the  carbonate,  and  there- 
fore less  likely  to  be  absorbed,  the  data  obtained 
from  recent  experiments  are  conflicting.  Lead 
sulphate  can  therefore  not  be  regarded  as  a  sub- 
stitute for  the  carbonate,  since  it  would  only  be 
replacing  one  lead  paint  by  another. 

As  I  wished  to  know  the  opinion  of  British 
master  painters  and  decorators  upon  the  relative 
merits  of  zinc  white  and  lead  carbonate,  I  applied 
to  the  Employers'  Association,  and  in  April,  1913, 
received  the  following  information  :  Of  45  master- 
painters  who  replied,  43  expressed  themselves  in 
favour  of  white  lead  for  the  exterior  of  buildings  ; 
for  inside  work  17  preferred  zinc  white  to  lead. 
For  internal  decoration  there  is  no  reason  why 
zinc  white  should  not  be  more  frequently  used 
than  it  is,  but  for  the  external  painting  of  houses 


64  LEAD  POISONING 

the  majority  of   master-painters  seem   to   be   in 
favour  of  lead  paint. 

There  is  a  hygienic  aspect  of  house-painting  to 
which  attention  ought  to  be  drawn.  I  refer  to  the 
antiseptic  properties  of  paints.  Two  years  ago 
Professor  H.  J.  Hutchens  and  I  carried  out  a 
series  of  experiments  with  various  paints  to  test 
their  germicidal  powers.  The  micro-organism 
used  was  the  Bacillus  coll.  The  experiments  ex- 
tended over  a  period  of  three  and  a  half  months. 
We  found  that  vapour  from  drying  paint  at  y]°  C. 
possessed  definite  bactericidal  properties ;  it 
retarded  and  prevented  the  growth  of  micro-organ- 
isms. Paints  which  had  been  dried  for  forty-eight 
hours  exercised  a  similar  influence,  but  after  five 
days  they  no  longer  possessed  such  power.  Simi- 
lar results  were  obtained  by  H.  A.  Gardner.  Like 
myself,  he  attaches  considerable  importance  to  the 
circumstance,  for  by  painting  chambers  with  an 
oil  pigment  we  have  an  efficient  means  of  destroy- 
ing bacteria  in  rooms  which  have  been  occupied 
by  persons  who  were  the  subjects  of  contagious 
disease.  During  painting  the  rooms  should  be 
well  ventilated,  but  when  finished  they  should  be 
closed  for  a  day  or  two,  to  allow  of  the  vapours 
exercising  their  antiseptic  influence  upon  the  walls 
and  contents. 


LEAD  POISONING  AMONG  PAINTERS         65 

Lead  Poisoning  among  Painters 

In  Great  Britain  it  is  difficult  to  estimate  the 
amount  of  lead  poisoning  in  painters,  owing  to 
notification  of  plumbism  being  voluntary,  also  to 
the  fact  that  house  and  ship  painting  do  not  come 
within  the  Factory  Act.  The  figures  received 
under  voluntary  notification  show  lead  poisoning 
to  be  even  more  prevalent  among  painters  than 
was  expected,  also  that  it  is  increasing.  These 
remarks  apply  equally  to  painters  in  Germany, 
France,  Austria,  and  the  United  States.  Painters 
have  a  higher  mortality  than  the  general  popula- 
tion. In  Berlin  in  1903  the  general  death  rate 
per  1,000  inhabitants  was  ir6i,  but  for  painters  it 
was  14.  Fleck*  gives  as  the  mortality  rates  of 
German  painters  1*3  per  cent,  from  lead  poisoning  ; 
nervous  diseases,  7*8  per  cent. ;  heart,  kidney  and 
liver  disease,  20*8  per  cent.  Figures  taken  from 
the  Prudential  Insurance  Company  of  America 
show  the  deaths  from  the  same  causes  to  be 
1 '5,  io#7,  and  35*0,  per  cent,  respectively.  Among 
German  painters  diseases  of  the  respiratory  organs 
caused  41*6  per  cent,  of  deaths,  and  in  the  United 
States  263  per  cent. 

Taking  all  the  paint  industries — and  in  these  are 

*  Weyl,  "  Handbuch-  der  Arbeiter  Krankheiten,"  p.  513, 
Jena,  1908. 

5 


66  LEAD  POISONING 

included  house,  coach,  ship,  and  automobile  paint- 
ing— the  cases  of  plumbism  reported  to  the  Home 
Office*  were:  154  cases  with  4  deaths  in  1908; 
197  cases  with  9  deaths  in  1909  ;  159  cases  with  12 
deaths  in  1910  ;  316  cases  with  12  deaths  in  191 1  ; 
and  204  cases  with  12  deaths  in  1912.  Coach- 
painting  furnishes  the  largest  number  of  cases  of 
plumbism. 

Between  1900  and  1909  there  were  reported  to 
the  Home  Office  1,973  cases  of  lead  poisoning 
with  380  deaths  of  house-painters.  In  the  tables 
furnished  by  Dr.  Legge  one  important  fact  stands 
out,  and  that  is  the  large  amount  of  paralysis 
among  the  men.  Tancquerel  des  Planches  found 
the  percentage  of  paralysis  in  lead-poisoned  French 
house-painters  to  be  8,  and  Teleky  14*5  in  Aus- 
trian painters.  During  the  period  above  men- 
tioned the  British  tables  show  the  percentage  to 
be  227.  Teleky  distinguishes  between  painters 
employed  on  the  outside  of  buildings  and  those 
employed  in  decorating  rooms.  Of  100  painters  of 
the  interior  of  houses,  31*2  of  the  men  were  off  ill 
annually — 0*7  from  lead  poisoning,  and  3*4  from 
tuberculosis ;  while  of  100  painters  employed  on 
outside  work,  47*4  of  the  men  were  off  ill  annually 
— yy  from  plumbism,  and  4*3  from  tuberculosis.    If 

*  Annual  Report  of  the  Chief  Inspector  of  Factories, 
1912. 


LEAD  POISONING  AMONG  PAINTERS         67 

the  figures  for  Berlin  are  taken,  there  were  between 
1900  and  1909  on  an  average  376  men  off  ill  per 
year ;  if  100  members  only  are  considered,  46^9  men 
were  off  ill  per  year — 8'ii  of  these  from  plumbism. 
The  smaller  number  of  cases  of  lead  poisoning 
among  the  Vienna  painters  who  were  employed  on 
inside  work  is  to  be  explained  by  the  circumstance 
that  other  metals  than  lead  were  being  used  in  the 
paint :  for  if  similar  lead  paint  had  been  used 
internally  as  externally,  the  cases  would  have  been 
more  numerous.  That  is  the  conclusion  we  come 
to  from  the  following  :  In  Vienna,  for  internal 
painting,  there  were  used  annually  1,600  hundred- 
weights of  white  lead.  This  amount  of  material 
caused  163  cases  of  lead  poisoning.  For  outside 
painting  4,750  hundredweights  were  used,  and 
this  gave  rise  to  50  cases  of  lead  poisoning. 

In  the  United  States  it  was  found  that  1  in 
every  6  painters,  and  in  Austria  1  in  4,  gave  a 
history  of  having  had  plumbism  in  one  or  other  of 
its  minor  forms  ;  but,  bearing  in  mind  what  has 
been  stated  in  the  preceding  pages  regarding  the 
increase  in  the  number  of  drying  agents  now  used, 
it  is  more  than  probable  that  part  of  the  illness  the 
men  suffered  from  was  of  the  nature  of  an  intoxi- 
cation from  turpentine  and  its  congeners,  or  from 
carbon  monoxide,  as  suggested  by  Gardner,  rather 
than  lead  ;  for  if  there  is  one  circumstance  peculiar 


68  LEAD  POISONING 

to  the  plumbism  of  painters,  it  is  that,  owing  to 
the  gradual  absorption  of  lead,  the  malady 
develops  slowly  and  is  usually  associated  with 
some  such  lesion  of  the  nervous  system  as  paraly- 
sis or  with  implication  of  the  kidneys.  It  is 
seldom  that  a  painter  dies  from  uncomplicated  and 
acute  lead  poisoning. 

Among  the  common  complaints  of  painters  may 
be  mentioned  constipation  and  headache.  Some 
writers  state  that  50  per  cent,  of  the  men  suffer 
thus.  This  is,  I  think,  pitching  the  number  too 
high.  House,  ship,  and  coach  painters  are 
credited  with  a  large  number  of  ailments,  of  which 
the  following  may  be  mentioned  : 

Colic,  ringing  noises  in  the  ears,  vertigo,  rheu- 
matic pains,  nocturnal  micturition,  disagreeable 
taste  in  the  mouth,  disordered  sensations,  imper- 
fect vision,  epistaxis,  loss  of  appetite,  sleepless- 
ness, diarrhoea,  tremors,  gout,  and  depression  of 
spirits. 

Manufacture  of  China  and  Earthenware 

This  important  industry,  although  met  with  in 
various  parts  of  England  and  Scotland,  is  mostly 
located  in  the  north  of  Staffordshire,  where,  when 
first  commenced,  it  was  close  to  the  clay  and  coal 
fields,  and  where  at  the  present  time  it  gives 
employment    directly    and    indirectly    to    several 


CHINA  AND  EARTHENWARE  69 

thousands  of  people.  The  district  is  known  as  the 
Potteries.  The  manufacture  of  pottery  is  a  frequent 
cause  of  plumbism,  owing  mainly  to  the  presence 
of  lead  in  the  glaze — that  is,  the  liquid  into  which 
the  ware  is  dipped.  When,  in  1S9S,  Sir  Edward 
Thorpe  and  I  were  sent  by  the  Home  Secretary  to 
the  Potteries  to  inquire  into  the  prevalence  of  lead 
poisoning  among  the  workpeople,  we  found  several 
of  the  small  master-potters  using  glazes  which  con- 
tained 20  to  30  per  cent,  or  more  of  raw  lead.  By 
reducing  the  amount  of  lead  in  this  glaze,  and  the 
Home  Office  introducing  other  reforms,  lead 
poisoning  in  the  manufacture  of  pottery  has 
during  the  last  decade  considerably  declined. 
Exposure  of  workpeople  to  small  quantities  of 
lead  dust  over  an  extended  period  is  sufficient  to 
cause  symptoms  of  plumbism.  Although  in  pottery 
workers  the  percentage  of  paralysis  is  fairly  high, 
it  is  not  always  proportional  to  the  length  of 
employment  in  the  factory.  In  only  a  small 
percentage  of  persons  working  in  pottery  is  lead 
poisoning  fatal — only  o'l  in  persons  employed  in 
lead  processes,  or,  in  other  words,  1  in  1,000.  The 
following  are  the  numbers  of  cases  of  lead  poison- 
ing and  the  deaths  notified  to  the  Home  Office  as 
occurring  in  the  china  and  earthware  trades  of  the 
United  Kingdom  : 


7o 


LEAD  POISONING 


1900. 

1901. 

1902. 

1903. 

1904. 

1905. 

1906. 

1907. 

1908. 

1909. 

1910. 

1911. 

1912. 

80 
14 

Cases 
Deaths 

200 

8 

106 
5 

87 
4 

97 
3 

106 
4 

84 
3 

107 
4 

103 
9 

117 
12 

58 
5 

77 
11 

92 
6 

It  is  noteworthy  that,  while  there  is  a  marked 
declension  in  the  number  of  cases  of  lead  poisoning 
notified  as  occurring  in  lead  workers,  the  sliding 
scale  is  not  uniform,  but  interrupted.  The  deaths 
from  plumbism  have  not  fallen,  but  risen,  as  the 
cases  notified  have  become  fewer. 

To  explain  the  rising  mortality  rate,  it  is  possible, 
as  some  writers  maintain,  that  medical  men  are 
straining  to  bring  within  the  category  of  death 
from  lead  poisoning  diseases  due  to  other  causes. 
The  modern  medical  practitioner  is  more  familiar 
with  chronic  plumbism  that  was  his  predecessor, 
so  there  may  be  a  disposition  on  the  part  of  some 
of  them  to  attribute  to  lead  deaths  due  to  other 
causes.  On  the  other  hand,  opposed  to  this  is  the 
important  fact  that  deaths  are  still  taking  place 
from  lead  without  the  true  cause  being  recognized. 

Fourteen  years  ago  Sir  Edward  Thorpe  and  I, 
in  our  report  to  the  Home  Secretary,  recommended 
that  there  should  be  a  considerable  reduction  in 
the  amount  of  lead  in  the  glaze ;  that  the  lead 
should  be  "fritted,"  so  as  to  render  it  more 
insoluble ;  that  wherever  possible  leadless  should 


CHINA  AND  EARTHENWARE  y\ 

be  substituted  for  leaded  glazes ;  and  that  female 
labour  should  be  abolished  in  certain  depart- 
ments wherein  lead  or  its  compounds  are  used. 
"  Fritted  "  lead,  which  is  made  by  firing  white 
lead  with  silica  or  boric  acid,  is  a  brittle,  glass- 
like material.  Thus  "  fritted,"  or  "  vitrified,"  the 
lead  becomes  less  soluble  in  acids,  and  therefore 
less  dangerous  to  the  workers,  than  the  carbonate 
of  lead.  Where  lead  carbonate — i.e.,  raw  lead 
— is  used  in  a  factory,  the  men  who  mix  the  glaze, 
the  dippers  who  plunge  the  ware  into  it,  and  the 
dippers'  assistants  who  remove  and  carry  away  the 
ware,  incur  the  risk  of  becoming  poisoned  by  lead. 
In  dipping  the  ware  into  the  glaze  the  men  work 
with  their  sleeves  rolled  up  ;  they  immerse  the 
pieces  quickly,  swirl  them  round  when  lifting 
them  out  of  the  tub,  and  as  a  consequence  there  is 
a  good  deal  of  splashing.  The  material  splashed 
upon  the  floor  and  bench  becomes  dried,  and  is 
subsequently  raised  into  the  air  of  the  dipping- 
room  in  the  form  of  very  fine  dust.  It  is  therefore 
desirable  that  the  lead  in  the  glaze  should  be 
changed  into  such  a  chemical  and  physical  state 
as  to  be  rendered  comparatively  insoluble  in  the 
stomach  if  swallowed,  or  in  the  respiratory 
passages  if  inhaled.  When  fritted,  lead  fulfils 
this  requirement,  for  when  melted  at  a  high  tem- 
perature with  silica  the  metal  becomes  imprisoned 


72  LEAD  POISONING 

in  such  a  manner  as  to  be  attacked  less  readily  by 
the  acid  of  the  gastric  juice,  and  therefore  less 
likely  to  be  absorbed  into  the  system.  If  the  frit- 
ting has  been  well  done,  only  a  minute  quantity  of 
the  lead  remains  in  a  soluble  form.  Glazes  made 
with  fritted  lead  are  spoken  of  as  glazes  of  a  low 
solubility.  As  a  result  of  experiments  carried  out 
by  Thorpe,  it  was  evident  that  there  ought  to  be  in 
pottery  manufacture  a  standard  of  insolubility  for 
fritted  lead  glazes.  The  standard  of  insolubility 
recommended  was  that  glazes  should  not  yield 
more  than  2  per  cent,  of  lead,  calculated  as  lead 
monoxide,  when  acted  upon  by  a  weak  solution  of 
hydrochloric  acid  under  certain  specified  condi- 
tions. This  2  per  cent,  standard  of  insolubility 
was  regarded  by  the  manufacturers  as  too  high.  A 
compromise  between  the  manufacturers  and  the 
Home  Office  was  effected,  and  a  standard  of  5  per 
cent,  insolubility  agreed  to. 

A  test  which  gives  approximately  the  amount  of 
lead  in  pottery  glaze  has  been  suggested  by  Mr. 
H.  R.  Rogers,*  H.M.  Inspector  of  Factories. 
This  consists  in  treating  glaze  with  hydrofluoric 
acid  for  forty  seconds,  and  of  absorbing  the  liquid 
with  filter-paper.  The  lead  is  precipitated  on  the 
paper  as  sulphate ;  thereafter  any  of  the  sulphate 

*  "  Report  of  a  Series  of  Experiments  for  Determining 
the  Amount  of  Lead  in  the  Glaze  of  Finished  Ware." 


CHINA  AND  EARTHENWARE  73 

which  is  soluble  in  water  is  washed  away.  The  lead 
on  the  paper  is  precipitated  as  sulphide ;  the  tints 
produced  vary  according  to  the  proportion  of  lead 
in  the  glaze.  In  Austria  a  rough-and-ready  test 
is  made  upon  pottery  by  the  factory  inspectors. 
In  some  parts  of  the  country  cooking  utensils  are 
dipped  in  glazes  rich  in  raw  lead.  These  with 
other  kinds  of  domestic  ware  are  sold  in  the 
market-place.  The  factory  inspector  takes  certain 
dishes,  and  pours  upon  them  a  small  quantity  of 
diluted  acetic  acid.  After  a  few  minutes  the  fluid 
is  poured  off  and  tested  for  lead  with  a  sulphide. 
If  the  brown  tint  obtained  is  of  such  a  depth  as 
to  indicate  the  presence  of  lead  in  considerable 
quantity  the  ware  is  not  allowed  to  be  sold.  Since 
the  publication  of  the  Thorpe-Oliver  report,  sub- 
sequent Home  Office  Committees  have  reported 
upon  the  prevalence  of  lead  poisoning  among 
potters,  and  introduced  improvements,  with  the 
result  that,  although  the  conditions  are  not  as 
satisfactory  as  they  ought  to  be,  they  yet  show  con- 
siderable improvement  to  those  which  existed  a 
few  years  ago.  In  the  following  table  is  given  the 
number  of  cases  of  lead  poisoning  among  dippers 
and  ware  cleaners  in  the  United  Kingdom,  taken 
from  the  Annual  Report  of  the  Chief  Inspector  of 
Factories  for  1912  :• 


74 


LEAD  POISONING 


Cases  of  Lead  Poisoning  among  Pottery  Workers  in 
Great  Britain. 


Processes. 

T3 

>. 

O 

"5.  . 
5  S- 

-0 

O    N 

a  « 

a;  o\ 

<£ 
0 

Cases  reported. 

Attack  Rate  per  1,000 
employed. 

Average. 

Average. 

ion. 


1907- 

1910. 

1903- 
1906. 

1899- 
1902. 

1912. 

1911. 

1907- 
1910. 



1903- 

1906. 

1899- 
1902. 

In    dipping- 
house : 

Dippers         p ' 

Dippers'     fM. 
Assistants  \  F. 

786 
150 

463 
397 

18 

3 

6 

16 
6 

2 
14 

17 
6 

3 
13 

18 
4 
3 

18 

26 

7 

7 

17 

23 

7 
15 

20 

40 

4 

35 

22 

40 

7 

33 

23 
30 

7 
46 

34 
68 

15 

45 

Ware       fM. 
Cleaners  \F. 

115 
461 

1 

15 

15 

1 
15 

2 

18 

3 
3° 

9 
33 

33 

9 
33 

20 
41 

30 

65 

Total    {£■ 

1364 

22 

18 

21 

23 

36 

16 

13 

15 

17 

27 

1008 

21 

35 

34 

40 

54 

21 

35      34 

42 

5« 

Dipping  is  anything  but  cleanly  work.  The 
hands  and  forearms  of  the  dipper  are  repeatedly 
being  dipped  into  glaze  containing  lead.  One  in 
forty-three  of  these  men  suffer  from  plumbism, 
probably  more  from  inhaling  the  dried  lead  glaze 
than  from  absorption  through  the  skin. 

Dippers'  assistants  are  usually  young  persons. 
At  present  young  persons  of  fifteen  years  of  age 
may  be  employed ;  but  where  lead  glazes  are  used 
no  great  hardship  would  be  inflicted  if  the  age  was 
raised  to  seventeen.  Female  dippers'  assistants 
are  more  liable  to  plumbism  than  male  assistants, 
as  seen  from  the  table. 


CHINA  AND  EARTHENWARE 


75 


In  some  factories,  particularly  in  France,  gloves 
are  worn  by  the  men  and  women  who  dip  the  ware, 
or  the  pieces  are  lifted  by  means  of  tongs,  and 
thereby  immersed  in  the  glaze.  The  less  there 
is  of  splashing  and  the  cleaner  a  dipping-house  is 
kept,  so  will  dippers  and  their  assistants  be  freer 
from  plumbism,  for  it  is  the  dried  glaze  on 
the  floor,  the  tubs,  benches,  boots  and  clothes 
of  the  workpeople,  which  constitutes  the  danger. 
Much  good  would  be  effected,  too,  by  washing  or 
swilling  of  the  floor  every  day  or  two. 

In  my  earlier  visits  to  the  Potteries,  I  was 
struck  by  the  large  amount  of  sickness  among  the 
majolica  paintresses.  Many  of  them  looked  ill. 
They  were  pale  and  the  subjects  of  saturnine 
cachexia.  At  the  periods  I  refer  to,  glazes  con- 
taining large  quantities  of  raw  lead  were  being 
used.  Majolica  painting  is  not  skilled  work.  The 
glaze  is  roughly  applied  by  hand  ;  many  of  the 
women  are  careless,  and  there  is  much  splashing 
of  the  glaze.  Among  majolica  painters  the  cases 
of  lead  poisoning  reported  for  1912  were  1  male 
and  3  females;  in  1911  no  males,  4  females.  In 
enamel  colouring  and  glaze  blowing  there  were 
2  cases  of  lead  poisoning  in  males  in  1912,  and 
11  in  females  ;  in  191 1  no  males,  2  females. 
Persons  employed  in  making  litho  transfers  for 
the  transfer  of  colours  to  china  and  earthenware 
are  exposed  to  the  risks  of  plumbism. 


76  LEAD  POISONING 

Manufacture  of  Pottery  as  a  Home 
Industry 

In  Great  Britain  we  see  nothing  of  the  injury 
to  health  brought  about  by  the  manufacture  of 
pottery  in  the  home  such  as  is  seen,  for  example, 
in  Hungary.  In  order  to  study  the  question,  I 
have  visited  Hungary  on  four  occasions.  The 
pursuits  of  the  people  are  mostly  agricultural. 
Here  and  there,  scattered  throughout  the  country, 
are  villages  occupied  by  working  potters  who  carry 
on  their  trade  in  the  home.  The  rooms  in  which 
the  family  live  and  sleep  are  those  in  which  the 
clay  is  turned  and  the  ware  dipped ;  and  as  there 
are  large  quantities  of  raw  lead  in  the  glaze,  not 
only  do  many  of  the  potters  themselves  suffer  from 
lead  poisoning,  but  also  the  women  and  children. 
On  the  occasion  of  my  visit  to  Hodmezovasarhely, 
eighty  master-potters  met  me  to  discuss  questions 
as  to  whether  something  could  not  be  done  to 
diminish  or  abolish  the  ravages  of  plumbism. 
Nearly  one-half  of  the  men  who  met  me  were 
paralyzed  in  the  legs  or  face.  Most  of  them  were 
under  forty  years  of  age.  Some  of  them  had  been 
paralyzed  five  or  six  years.  Several  of  the  wives 
and  children  were  also  paralyzed.  A  few  of  the 
children  were  blind  as  a  consequence  of  saturnine 
encephalopathy ;  others  were  imbecile  and  had 
never  walked,  although  upwards  of  four  years  of 


POTTERY  AS  A  HOME  INDUSTRY  77 

age.  In  another  village — Csakvar — I  found  the 
potters  were  using  a  glaze  containing  60  per  cent, 
of  lead  carbonate.  The  dipping  of  the  ware  was 
carried  on  in  the  same  room  as  that  in  which  the 
family  lived  and  slept.  On  analyzing  the  dust 
taken  from  the  shelves  of  the  rooms.  Dr.  Adalbert 
Chyzer,  who  accompanied  me,  found  that  it  con- 
tained 0*63  to  i'o8  per  cent,  of  lead.  He  also 
found  in  the  blouse  worn  by  a  little  boy,  the  son 
of  a  potter,  0*243  grain  of  lead,  and  in  his  cap 
0*0144  grain  of  lead.  In  the  clothes  which  en- 
wrapped an  infant  lying  in  its  cradle  lead  was 
also  found.  On  the  gums  of  some  of  the  children 
I  observed  a  well-marked  blue  line.  Many  of  the 
boys  and  girls  were  anaemic. 

The  children  of  these  Hungarian  potters  are 
born  into  and  reared  in  an  atmosphere  impreg- 
nated with  lead,  owing  to  the  glaze  on  the  floor, 
which  has  been  splashed  from  the  dipping-tub, 
becoming  dried  and  raised  into  the  air  as  fine 
dust.  So  high  is  the  infant  mortality  rate  that 
in  some  of  the  pottery  villages  there  is  hardly  a 
child  to  be  seen.  In  the  homes  of  the  potters 
domestic  animals  can  hardly  live.  This  is  especi- 
ally true  of  cats.  A  few  years  ago,  at  the  request 
of  the  Home  Secretary  of  Hungary,  I  reported 
upon  the  lead  poisoning  of  the  potters,  and  I 
recommended  to  the  Government,  among  other 
things,  the  advisability  of  having  the  dipping  and 


78  LEAD  POISONING 

drying  of  the  ware  carried  on  away  from  the 
homes  of  the  potters,  in  a  communal  workshop, 
also  the  necessity  of  using  smaller  percentages  of 
lead,  and  where  possible  the  use  of  fritted  instead 
of  raw  lead.  In  August,  1913,  I  was  again  in 
Hungary,  and  at  the  request  of  the  Minister  of 
Commerce  I  visited  Csakvar  with  M.  Szanto,  of 
the  Museum  of  Social  Service,  Budapest,  in  order 
to  see  for  myself  the  manufacture  of  pottery  under 
the  conditions  I  had  recommended.  In  passing 
through  Csakvar  we  were  joined  by  Dr.  Grasser, 
with  whom  five  years  previously  I  had  discussed 
the  problem  of  how  to  prevent  lead  poisoning  of 
the  potter,  his  wife  and  children.  At  the  com- 
munal workshop,  where  fritted  lead  glaze  is  made 
and  sold  and  dipping  of  the  ware  carried  on,  we 
met  Count  Esterhazy,  who  with  his  father  has 
played  an  important  part  in  trying  to  improve 
the  health  conditions  under  which  pottery  as  a 
home  industry  is  carried  on  in  Hungary.  On 
visiting  the  homes  of  the  potters  who  bought  and 
used  the  fritted  lead,  not  only  were  they  cleaner 
and  brighter  than  those  who  still  adhered  to  the 
old  custom  of  mixing  the  glaze  in  the  living-room, 
and  of  dipping  the  ware  therein,  but  the  health 
of  the  potters  had  considerably  improved.  So 
much  was  this  the  case  that  Dr.  Grasser,  in  his 
desire  to  find  for  me  a  lead-poisoned  potter's 
child,  had  sought  through  all  the  village  without 


POTTERY  AS  A   HOME  INDUSTRY  79 

finding  one.  The  following  table,  kindly  supplied 
to  me  by  Dr.  Grasser,  shows  how  severely  scourged 
with  lead  poisoning  Csakvar  has  been  since  igoo, 
and  the  satisfactory  declension  since  the  manu- 
facture of  pottery  has  become  less  of  a  home 
industry.  From  igoo  to  igi2  Dr.  Grasser  treated 
434  cases  of  lead  poisoning — 322  men  and  102 
women.     Children  are  not  included. 


It  is  not  contended  that  the  fewer  cases  of  lead 
poisoning  during  the  last  few  years  are  entirely 
the  result  of  the  recommendations  made  by  the 
Hungarian  medical  men  and  myself  in  igoS,  for 
the  number  of  families  engaged  in  the  manu- 
facture of  pottery  has  declined,  the  men  have 
become  more  temperate  as  regards  the  use  of 
alcohol,  and  many  of  them  have  taken  up  agri- 
cultural work  during  certain  periods  of  the  year; 


80  LEAD  POISONING 

but  notwithstanding  these,  the  campaign  against 
plumbism  in  the  Hungarian  villages  has  been 
followed  by  encouraging  results  owing  to  the  im- 
proved conditions  under  which  the  work  is  now 
carried  on.  There  have  been  fewer  cases  of  plum- 
bism among  the  married  women,  whilst  amongst 
the  children  the  malady  has,  practically  speaking, 
disappeared. 

The  large  number  of  trades  in  which  lead  is 
used,  and  with  injury  to  the  persons  occupied  in 
them,  makes  it  impossible  for  me  to  deal  with 
each  trade  separately,  and  to  point  out  the 
dangers  incidental  to  it.  One  or  two  trades,  how- 
ever, may  be  mentioned.  File-cutting  by  hand  is 
one.  Among  file-cutters  the  sickness  and  mor- 
tality rates  from  plumbism  and  tuberculosis  are 
high.  The  transverse  and  crossed  marks  which 
are  seen  on  a  file  are  made  by  hand  by  means  of  a 
chisel  and  hammer.  The  tool  about  to  be  dealt 
with  is  strapped  on  to  a  bed  or  cushion  of  metallic 
lead.  After  having  been  cut  on  one  side,  the  file- 
cutter  reverses  the  file,  at  the  same  time  rubbing 
it  with  charcoal  or  chalk.  Chisel  and  hammer 
are  again  used,  and  in  doing  so  much  fine  dust 
is  raised.  In  dust  removed  from  the  wooden 
"  stock  "  on  which  the  man  or  woman  sits  astride 
when  cutting  the  file,  there  was  found  14*82  and 
22*28  grains  of  lead  per  100.  Most  of  this  is  lead 
in  metallic  form,  but,  as  oxidation  is  always  going 


POTTERY  AS  A  HOME  INDUSTRY  81 

on,  much  of  the  lead  is  being  constantly  trans- 
formed into  a  readily  soluble  oxide.  Sheffield  is 
the  cradle  of  the  file-cutting  industry,  and  there  it 
is  carried  on  also  in  the  homes.  The  workshops 
and  dwelling-houses  in  which  the  trade  is  carried 
on  are  dirty.  File-cutters  are  not  a  cleanly  body 
of  men.  To  want  of  cleanliness,  to  inhalation  of 
dust,  to  the  habit  of  not  washing  before  eating, 
also  to  working  in  close  and  ill-ventilated  rooms, 
must  be  attributed  the  high  mortality  of  file- 
cutters  hitherto.  File-cutters  are  no  longer  igno- 
rant of  the  dangers  of  their  occupation,  so  that 
while  in  1899  and  igoo  there  were  41  and  40  cases 
of  lead  poisoning  notified,  with  1  and  3  deaths 
respectively,  in  1909  there  were  only  8  cases 
reported  and  no  deaths. 

During  the  ten  years  1900  to  1909  inclusive 
there  were  reported  in  the  United  Kingdom 
241  cases  of  plumbism  in  file-cutters.  Of  these 
19  terminated  fatally.  As  the  men  who  temper 
or  harden  the  files  by  plunging  them  into  a 
bath  of  molten  lead  also  incur  the  risk  of  be- 
coming lead-poisoned,  hoods  ought  to  be  erected 
above  the  baths,  so  that  the  fumes  are  carried 
away  from  the  workers.  Instead  of  plunging  the 
cut  files  into  a  bath  of  molten  lead  in  order  to 
harden  them,  the  same  result  can  be  obtained  by 
inserting  them  between  hot  iron  bars,  and  in  this 

6 


82  LEAD  POISONING 

way  one  danger  is  at  least  got  rid  of.  Attempts 
have  been  made  to  replace  by  various  substitutes 
the  lead  cushion  on  which  the  file  is  cut,  but  so 
far  no  pad  has  been  found  which  possesses  the 
elasticity  and  other  required  properties  offered  by 
lead.  File-cutters  are  extremely  conservative  in 
their  work,  and  are  averse  to  innovations.  So, 
too,  are  the  men  who  use  the  files.  Machine-made 
files  are,  however,  coming  more  into  general  use, 
and  they  are  gradually  replacing  those  made  by 
hand.  In  one  way  and  another  a  change  is  creep- 
ing over  the  file-cutting  industry  of  this  country. 

Electrical  Accumulator  Works 

The  increasing  uses  to  which  electricity  is  being 
applied,  and  the  growing  demand  for  storage 
batteries,  have  given  an  impetus  to  electrical 
accumulator  works  both  at  home  and  abroad.  A 
paste  made  of  red  lead  and  sulphuric  acid  is 
rubbed  into  the  perforated  metal  plates  which  are 
used  in  the  construction  of  electrical  batteries. 
In  rubbing  in  the  paste  the  men  wear  indiarubber 
gloves,  but  as  a  result  of  friction,  also  of  wear  and 
tear,  the  gloves  become  thin  and  torn,  so  that 
through  the  slits  in  the  gloves  some  of  the  paste 
gets  rubbed  into  the  skin.  The  men  who  mix  the 
red  lead  and  acid  are  exposed  to  dust.  During 
eleven  years  ending  1909,  there  were  317,  not 
including  6  fatal,  cases  of  lead  poisoning  notified 


PRINTING  AND  TYPE  FOUNDING  83 

as  occurring  in  men  employed  in  electrical  accu- 
mulator works.  Most  of  the  plumbism  occurs  in 
the  men  who  are  employed  in  the  mixing  depart- 
ment, but  their  fellow-workmen  who  cast  the 
plates,  and  those  who  solder  them  by  means  of  a 
blowpipe,  also  suffer  from  saturnism  by  inhaling 
the  fumes. 

Printing  and  Type  Founding 

Another  occupation  in  which  the  dangers  of 
lead  poisoning  are  frequently  observed  is  that  of 
printing,  also  type  founding.  In  addition  to 
plumbism,  printers  are  peculiarly  liable  to  tuber- 
culosis, owing  to  the  work  being  carried  on  in 
close,  warm,  and  ill-ventilated  rooms,  whereby  the 
possibility  of  infection  is  favoured.  Some  writers 
maintain  that  lead  poisoning  of  itself  predisposes 
to  tuberculosis.  The  only  way  in  which  it  can  do 
so  is  by  reducing  the  general  vital  resistance  of  the 
individual.  When  tuberculosis  develops  in  a  lead- 
poisoned  person  the  phthisis  usually  runs  a  rapid  */ 
course.  Between  1900  and  1909  there  were  noti- 
fied 200  cases  of  plumbism  in  printers,  and  of 
these  17  were  fatal.  Considering  the  large 
number  of  printers  in  this  country,  it  cannot  be 
said  that  lead  poisoning  is  extremely  prevalent 
among  them,  and  yet  when  the  malady  develops 
the  symptoms  are  unusually  severe  and  persis- 
tent.      In    the    dust   given    off  by    British    type 


84  LEAD  POISONING 

14  per  cent,  of  lead  was  found,  but  this  is  only 
one-third  of  what  has  been  found  in  Continental 
printing-shops.  Type-founders  and  linotypists 
suffer  from  plumbism  through  inhalation  of  the 
fumes  of  the  molten  metal. 

If  we  take  the  statistics  of  the  London  Society 
of  Compositors,  it  will  be  observed  that  there  are 
fewer  cases  of  plumbism  among  the  members  than 
of  tuberculosis.  Professor  Halm*  of  Munich  has 
shown,  taking  the  figures  for  Vienna  and  Berlin 
from  1901  to  1907,  that  the  number  of  cases  of 
plumbism  and  the  mortality  from  tuberculosis  run 
concurrently.  In  Vienna  the  sickness  from 
plumbism  per  100  members  of  one  of  the  sick- 
clubs  during  eight  years  declined  48  per  cent., 
and  during  the  same  period  the  deaths  from 
tuberculosis  declined  57  per  cent.  In  Berlin 
during  the  years  1901  to  1907  lead  poisoning 
declined  46  per  cent.,  and  the  deaths  from  tuber- 
culosis 40  per  cent.  Comparing  the  polygraphic 
trades  one  with  another,  it  was  noticed  that,  while 
the  highest  figures  for  plumbism  were  given  by 
printers  and  type-founders,  the  highest  death-rate 
from  tuberculosis  also  occurred  in  printers  and 
type  founders.  Hahn  is  of  the  opinion  that  the 
predisposition  to  pulmonary  tuberculosis  on  the 
part  of  printers  is  the  result  of  chronic  lead  poison- 
ing ;  but  if  this  alone  were  the  cause,  why  should 
*  "  Die  Giesundheit." 


PRINTING  AND  TYPE  FOUNDING  85 

the  relationship  be  so  noticeable  in  printers,  to  the 
exclusion  of  other  trades?  We  do  not  find,  for 
example,  pulmonary  tuberculosis  prevalent  to  any 
abnormal  extent  in  white-lead  workers,  and  yet 
they  are  exposed  to  a  form  of  dust  finer  and  richer 
in  lead  than  are  printers.  Printers,  file-cutters, 
and  potters,  succumb  to  pulmonary  phthisis  in 
large  numbers,  a  circumstance  less  due  to  the 
chemical  than  to  the  physical  qualities  of  the  dust 
inhaled  and  the  conditions  under  which  it  is 
inhaled.  Other  factors  than  lead,  therefore,  are 
probably  in  operation  to  explain  the  high  mor- 
tality rate  of  tuberculosis  in  printers.  Infection, 
and  the  fact  of  the  work  being  carried  on  too 
frequently  in  overheated,  ill-ventilated,  and  arti- 
ficially-lighted rooms,  are  the  more  likely  causes. 

The  following  table,  taken  from  Hahn's  paper 
already  alluded  to,  bears  upon  the  subjects  I  have 
referred  to  ;  while  as  a  contribution  to  the  relation- 
ship of  tuberculosis  and  lead  poisoning  experi- 
ments carried  out  by  G.  Loriga*  may  be  men- 
tioned. To  ten  guinea-pigs  he  gave  for  one  month 
nitrate  of  lead  in  food,  to  ten  guinea-pigs  sulphate 
of  lead  was  given,  while  another  group  of  ten  were 
fed  normally.  Of  each  group  eight  were  infected 
with  tuberculosis.  The  animals  which  received 
lead  declined  in  weight  more  rapidly  than  those 
fed  normally.  The  nitrate-of-lead-fed  animals  lost 
*  77  Ramazzini,  1912,  Hft.  I.  and  II. 


86 


LEAD  POISONING 


Sickness  Rates  from  Lead  Poisoning  and  Death  Rates  from 
Tuberculosis,   per   ioo   Members,  of   Male    and    Female 
Members  of  the  Vienna  Book-Printers'  Sick-Fund. 
[I  =  Cases  of  lead  poisoning.     11  =  Deaths  from  tuberculosis.] 


Per  100 
members 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

Per  100 
members 

4.0 

4.0 

9 

9 

8 

8 

7 

7 

G 

6 

J 

S 

4 

4 

3 

3 

2 

2 

1 

J 

3.0 

3.0 

9 

9 

8 

a 

7 

\ 

7 

6 

\ 

6 

S 

\ 

S 

4 

\ 

4 

3 

\ 

1 — ■ 

3 

2 

2 

7 

I 

Z..0 

2.0 

9 

9 

8 

8 

7 

7 

6 

6 

5 

5 

4 

P 

4 

3 

3 

2 

2 

1 

1 

1.0 

1.0 

9 

9 

8 

8 

7 

7 

6 

6 

S 

S 

4 

4 

3 

II 

3 

2 

2 

I 

1 

0.0 

0.0 

PRINTING  AND  TYPE  FOUNDING 


87 


Sickness  Rates  from  Lead  Poisoning  and  Death  Rates  from 
Tuberculosis,  per   500  Members,  among  Compositors  and 
Printers  of  the  Berlin  Local  Sick-Fund  for  the  Book- 
Printing  Trades. 
[I  —  Cases  of  lead  poisoning.     11  =  Deaths  from  tuberculosis.] 


Per  500 

members 

1901 

1902 

1903 

1904 

1905 

1906 

1907 

Per  500 
members. 

4,9 

4,9 

8 

I 

8 

7 

7 

6 

6 

J 

5 

4 

4 

3 

3 

2 

2 

1 

1 

4-.0 

4,0 

9 

9 

8 

8 

7 

7 

6 

6 

S 

J 

4 

4 

3 

3 

Z 

2 

1 

1 

3,  a 

3,0 

9 

9 

8 

3 

7 

I 

7 

6 

6 

S 

II 

5 

4 

4 

3 

3 

2 

2 

; 

1 

2.0 

2,0 

9 

9 

8 

8 

7 

7 

6 

6 

S 

5 

4 

4 

3 

II 

3 

2 

^ 

1 

7 

ho 

1,0 

9 

9 

8 

8 

7 

7 

6 

6 

5 

5 

4 

4 

3 

3 

2 

2 

1 

7 

0,0 

O.O 

88  LEAD  POISONING 

weight  more  quickly  than  those  which  received 
sulphate.  One  of  the  nitrate-fed  animals  died  of 
lead  poisoning,  and  seven  of  the  tuberculous  group 
after  an  average  of  seventy-nine  days.  Those  of 
the  sulphate  group  died  after  an  average  of  ninety- 
one  days,  and  the  non-lead  animals  after  ninety- 
two  days.  Loriga  maintains,  as  a  result  of  these 
experiments,  that  plumbism  creates  a  predisposi- 
tion to  tuberculosis.  It  should  be  remembered, 
however,  that  there  is  only  one  day's  difference  as 
regards  the  date  of  death  between  the  sulphate- 
fed  animals  and  those  which  received  no  lead  at 
all.  Among  printers  and  lead-smelters,  as  in  all 
dusty  occupations,  the  effect  of  dust  and  tubercu- 
losis combined  is  always  greater  than  the  influence 
of  either  separately  ;  but,  as  already  stated,  there 
are,  as  regards  printers,  other  circumstances  in 
operation,  such  as  the  influence  of  overheated  and 
ill-ventilated  workrooms. 

Plumbing,  Dyeing,  Glass-making,  Tinning  of 
Hollow  Ware,  and  Diamond  Cutting 

Of  other  trades  in  which  lead  poisoning  occurs, 
mention  may  be  made  of  plumbing,  dyeing,  glass- 
making,  glass-polishing,  the  tinning  and  enamel- 
ling of  hollow  ware,  lace-making,  cutting  of 
precious  stones,  such  as  diamonds  and  rubies. 

Plumbers  suffer  from  saturnism  through  hand- 
ling metallic  lead  pipes,  through  using  red  and 


PRINTING  AND  TYPE  FOUNDING  89 

white  lead  for  jointing  purposes,  also  through 
handling  putty.  There  is  a  belief  that  putty  made 
with  white  lead  keeps  better  than  putty  made 
without  it,  and  that  the  putty  made  with  red  lead 
used  by  engineers  sets  more  quickly  and  hardens 
better.  Whatever  may  be  the  advantages  con- 
ferred upon  putty  by  lead,  its  presence  therein 
adds  considerably  to  the  risks  to  health  of  those 
who  use  it.  Many  cases  of  plumbism  have  been 
traced  to  the  use  of  putty  powder  in  the  polishing 
of  glass.  On  analysis  the  powder  has  been  found  to 
contain  as  much  as  70  per  cent,  of  lead  carbonate. 

Persons  employed  in  dyeing  yarn  by  chromate 
of  lead,  dyeing  of  silk  and  thread,  also  in  printing 
colours  upon  calico,  may  become  the  subjects  of 
plumbism. 

In  glass-works  where  electric  lamps  are  made  I 
have  observed  severe  forms  of  plumbism  in  men 
who  mix  the  sand,  salt  cake,  and  red  lead,  pre- 
paratory to  the  mixture  going  into  the  furnace. 
Unless  precautions  are  taken,  the  atmosphere  soon 
becomes  dusty  and  a  source  of  danger  to  those 
who  breathe  it.  I  have  seen  healthy  men  who, 
within  fourteen  weeks  of  having  taken  up  this 
employment  in  a  glass-works,  had  become  anaemic, 
had  lost  half  a  stone  in  weight,  and  were  suffering 
from  severe  headache.  On  examining  the  men  at 
work,  I  found  their  teeth  covered  with  red  particles 
of   the   oxide   of  lead,    so   that   in  these   men   a 


9o  LEAD  POISONING 

considerable  quantity  of  the  poison  was  becoming 
dissolved  in  the  mouth  and  was  being  swallowed. 
Dr.  Septimus  Bodger,  of  Studley,  Warwickshire, 
has  drawn  my  attention  to  several  cases  of  lead 
poisoning  among  women  and  girls  employed  in 
putting  glass  tops  on  the  long  hatpins  worn  by 
women.  In  many  of  the  workers  there  was  a  well- 
marked  blue  line  on  the  gums.  Most  of  them 
were  anaemic  ;  pregnant  females  had  miscarried  in 
larger  numbers  than  women  employed  in  other 
trades  in  the  district.  The  glass  which  was  used 
came  from  Germany,  and  contained  a  large 
quantity  of  lead. 

In  what  is  called  the  tinning  of  hollow  ware, 
the  interior  of  the  vessel  is  swilled  with  molten 
metal,  a  mixture  of  lead  and  tin.  As  tin  is  the 
more  expensive,  there  may  be  as  much  as  70  per 
cent,  of  lead  present  in  the  molten  metal  used  for 
tinning  cheap  goods.  Not  only  do  the  men  who 
swill  the  interior  of  hollow  ware  suffer,  but  the 
people  who  eat  the  food  which  has  been  cooked 
in  the  vessels  are  also  liable  to  be  poisoned  by 
lead.  Formerly  the  white  enamel  used  for  coating 
the  interior  of  culinary  ware  contained  large 
quantities  of  lead,  but  within  recent  years  this 
metal  has  been  replaced  by  a  harmless  substitute. 

In  the  enamelling  of  iron  baths,  the  men  who 
grind  the  fritted  lead  (boro-silicate),  and  who  put 
the  enamel  on  the  bath,  frequently  become  lead- 


PRINTING  AND  TYPE  FOUNDING  gl 

poisoned.  The  material  is  put  on  the  bath,  in  the 
form  of  a  fine  powder  through  a  sieve,  when  the 
iron  bath  is  still  extremely  hot,  the  temperature 
being  frequently  as  high  as  1,500°  F. 

I  have  known  an  engraver  become  paralyzed 
as  an  incident  in  his  occupation.  Although 
etching  is  made  on  copperplate,  there  is  fre- 
quently on  the  surface  a  small  quantity  of  lead. 
The  engraver  referred  to  was  in  the  habit,  when 
at  work,  of  putting  the  tip  of  the  steel  pencil  into 
his  mouth,  with  the  result  that  he  developed  a 
well-marked  blue  line  on  his  gums,  had  colic,  and 
suffered  from  double  wristdrop. 

We  do  not  find  plumbism  in  lace-workers  in 
Great  Britain,  but  on  the  Continent  it  is  not 
unknown,  owing  to  lead  being  added  to  increase 
the  weight  of  the  lace.  In  Austria  the  use  of  lead 
for  this  purpose  has  recently  been  prohibited. 

The  cutting  of  diamonds  is  an  old  industry  of 
Amsterdam.  At  the  time  of  my  visit  to  the 
diamond  cutting  shops  of  that  city  eight  years 
ago,  the  industry  gave  employment  to  8,000  men. 
The  rooms  in  which  the  men  work  are  overheated. 
In  order  to  cut  a  diamond  it  has  to  be  fixed  in  a 
mass  of  molten  metal,  the  size  of  a  walnut,  com- 
posed of  60  parts  of  lead  and  40  of  tin.  Thus 
fixed  it  is  polished  by  hand  or  by  a  small  wheel 
revolving  very  rapidly.  Owing  to  the  large 
amount  of  lead  dust,  usually  lead  oxide,  floating 


92  LEAD  POISONING 

in  the  atmosphere  the  men  suffer  from  colic  and 
wristdrop.  At  Reichenberg  in  Bohemia  similar 
symptoms  are  met  with  in  the  men  who  cut 
precious  stones. 

How  is  Lead  Poisoning  caused  ? 

Food  and  drinking  water  contaminated  by  lead 
are  sources  of  plumbism  ;  so,  too,  are  certain  occu- 
pations in  which  lead  is  carried  into  the  atmosphere 
in  the  form  of  fume  and  dust.  The  malady  occurs 
also  as  a  consequence  of  the  self-administration  of 
./diachylon,  or  lead  plaster,  for  the  purpose  of 
procuring  abortion.  Canned  foods,  particularly 
preserved  foods  which  have  an  acid  reaction — e.g., 
sliced  pineapple  —  become  possible  causes  of 
plumbism,  through  dissolving  out  the  lead  in  the 
solder.  One  of  my  patients,  an  unmarried  woman 
twenty-eight  years  of  age,  became  seriously  ill 
through  eating  tinned  salmon.  She  became 
anaemic,  developed  wristdrop,  her  gums  showed 
an  intense  blue  line,  and  her  urine  contained 
lead.  The  paralysis  slowly  disappeared,  but  her 
health  was  never  the  same  afterwards.  Two 
years  after  her  apparent  recovery  the  urine  still 
contained  lead. 

Drinking  water  gathered  on  peaty  ground  has 
frequently  an  acid  reaction,  and  is  capable  of 
dissolving  lead.     Water  possessing  plumbo-solvent 


HOW  IS  LEAD  POISONING  CAUSED?         93 

power  has  been  the  cause  of  widespread  suffering, 
owing  to  lead  poisoning  assuming  endemic  propor- 
tions. This  has  been  the  case  in  several  of  the 
towns  and  villages  of  Yorkshire.  The  plumbo- 
solvency  of  drinking  water  varies  with  the  season 
of  the  year.  It  is  apt  to  be  increased  at  the  end 
of  a  long  drought,  owing  to  the  rain  washing  out 
the  humic  or  ulmic  acid  contained  in  the  peat. 
Houston,  of  the  Local  Government  Board,  a  few 
years  ago  drew  attention  to  the  acidity  of  peat, 
and  the  part  it  plays  in  the  presence  of  bacteria. 
If  to  a  sterile  decoction  of  peat  micro-organisms 
obtained  from  peat  are  added,  the  liquid  becomes 
acid,  and  is  found  to  possess  strong  plumbo-solvent 
powers.  Two  non-motile,  non-liquefying  bacteria 
have  been  isolated  from  peat  by  Houston.  These 
organisms  possess  separately  the  properties  of 
acidity  and  plumbo-solvency.  In  my  own  experi- 
ments, drinking  waters  richest  in  bacteria,  not 
of  peaty  origin,  possessed  slightly  greater  solvent 
power  upon  lead  than  those  poor  in  micro- 
organisms. Distilled  water  attacks  lead  with 
greater  vehemence  than  might  be  expected.  In 
fact,  unless  glass  vessels  are  used  in  the  process 
of  distillation,  it  is  difficult  to  get  the  ordinary 
distilled  water  of  commerce  completely  free  from 
lead.  Ordinary  drinking  water  acts  upon  lead 
owing    largely   to    the   oxygen    dissolved   in    the 


94  LEAD  POISONING 

water.  The  presence  of  calcium  carbonate  in  the 
water  gives  a  protective  coating  to  the  interior  of 
lead  pipes,  provided  the  water  remains  free  from 
acid.  Such  salts  as  nitrates  and  chlorides  in 
water  exercise  a  distinctly  corroding  influence 
upon  lead.  Carbonic  acid  has  a  similar  influence. 
Silicates,  on  the  other  hand,  possess  protective 
properties.  On  the  addition  to  drinking  water  of 
fragments  of  limestone,  magnesium  limestone,  and 
chalk,  waters  which  were  previously  strongly 
plumbo  -  solvent  lose  this  property,  and  are 
rendered  safe  for  domestic  purposes.  Usually 
only  very  small  quantities  of  the  protective  agent 
are  required — e.g.,  2  to  3  grains  of  lime,  ij  grains 
of  powdered  chalk,  or  whiting,  added  to  the  gallon 
of  water,  being  sufficient.  One  method  which 
has  been  found  most  serviceable  is  filtering  of 
the  water  through  sand  rich  in  silicates  and 
strewn  with  fragments  of  limestone.  In  associa- 
tion with  my  colleague,  Professor  R.  A.  Bolam,  I 
have  carried  out  several  experiments  with  drinking 
waters  which,  owing  to  their  high  plumbo- 
solvency,  were  causing  widespread  and  serious 
harm,  further  extension  of  which  was  only  prevented 
by  prompt  and  appropriate  chemical  treatment  of 
the  water.  I  give  in  the  following  tables  the 
amounts  of  lead  dissolved  daily  by  50  c.c.  of 
drinking  water.  The  tables  show  what  can  be 
effected  by  treatment,  also  the  necessity  of  con- 


HOW  IS  LEAD  POISONING  CAUSED? 


95 


stant  watchfulness  on  the  part  of  a  water  company 
when  it  is  known  that  the  water  supplied  possesses 
strong  plumbo-solvent  powers.  Our  plan  is  to 
immerse  a  piece  of  lead  pipe  in  water,  and  to  leave 
it,  testing  the  fluid  daily. 


June,  1901. 

June,  1912. 

Unfil- 

tered 

Water. 

The  Same 
Water 
treated. 

Water  from 

Same  Source 

treated. 

June  15   ... 
„     16   ... 
„     17   ... 

„     18   ... 
„     19  ... 
„     20  ... 
„     21    ... 
„     22   ... 
»     23    ... 

»     24  ••• 
>,     25   ... 
,,     26   ... 
„     27  ... 
28 

„  29  ... 
„   30  ... 

07 

1-05 

1-25 

1-4. 

r8 
i-8 
19 

2'0 
2"I 

2"2 

2"3 
2-4 

2'4 

2'5 

2-6 
2-6 

0-15 

o*3 

o-35 

0-4 

0-4 

°"45 

°"45 

o-45 

o-45 

o-5 
o'5 
°"5 
o'5 
o'5 
o-5 

June  17    ... 

„     18    ... 
„     19    ... 
,,     20    ... 
„     21    ... 

,,     22    ... 

,,     23    ... 

M          24        ... 
„          25        ... 
„          26        ... 
„          27       ... 
„          28       ... 
„          29       ... 
„          SO       .- 

Pipes    im- 
mersed 
0-05 
o-i 

0-15 

0-2 
0-25 

No    deter- 
mination 
0-3 

o'35 

0-4 
0-4 
°'4 
°"4 
No    deter- 
mination 

The  above  are  amounts  of  lead  in  milligrammes  per  ^  litre 
of  water. 

Compare  with  these  the  amounts  of  lead 
dissolved  by  the  waters  supplied  by  another  water 
company  : 


96 


LEAD  POISONING 


M  (not  treated). 

N  (treated). 

July  9     ... 

Pipes  immersed 



,,     10     ... 

3'2 

o'5 

,     ii 

,      12       ... 

5 '3 
6-i 

o-55 
o-8 

,      13       ••• 

— 

°*95 

,      14       ••• 

— 

I/O 

,      15       ••• 

vi 

,      16       ... 

i'i 

The  above  are  amounts  of  lead  in  milligrammes  per  |  litre 
of  water. 

The  effect  of  treatment  is  apparent  in  N.  When- 
ever drinking  water  has  once  been  found  to  exhibit 
strong  plumbo-solvent  powers,  in  the  interests  of 
the  public  it  is  absolutely  necessary  that  the  water 
should  be  submitted  from  time  to  time  to  plumbo- 
solvency  tests,  for  the  capacity  of  the  water  to  take 
up  lead  varies  with  the  seasons  of  the  year,  also 
with  the  weather  ;  and,  besides,  the  silica  and  lime- 
stone which  form  the  protective  material  laid 
down  in  the  filtering  bed  are  being  gradually 
washed  away,  or  their  influence  is  weakened,  and 
ought  therefore  to  be  periodically  renewed. 

A  feature  of  the  widespread  plumbism  due  to 
contaminated  drinking  water  is  that  women  and 
children  are  likely  to  suffer  more  than  men,  and 
that  usually  there  is  among  the  adult  female  popu- 
lation a  larger  number  of  miscarriages.  Occasion- 
ally, in  some  of  the  towns  supplied  with  a  high 
plumbo-solvent  water,  the  number  of  miscarriages, 


FUME  97 

admittedly  difficult  to  know  accurately,  is  equal  to, 
if  not  greater  than,  the  live  births  in  the  affected 
area.  Another  point  of  interest,  too,  is  that  the 
destruction  of  immature  infant  life  occurs  without 
most  of  the  women  exhibiting  symptoms  of  lead 
poisoning,  or  even  showing  a  blue  line  on  their 
gums. 

Fume. 

Fume  escaping  from  the  stacks  of  a  lead-smelt- 
ing works  has,  as  we  have  seen,  caused  the  death 
of  animals  grazing  in  adjoining  fields.  It  is  a 
cause  of  sickness,  too,  in  the  men  who  smelt  the 
ore.  Some  men  are  more  readily  affected  by  fume 
than  others.  Symptoms  of  plumbism  may  de- 
velop slowly;  in  a  similar  manner,  structural 
changes  in  the  internal  organs,  such  as  the  kidneys 
and  arteries  may  develop  slowly  and  insidiously, 
and  cause  cerebral  haemorrhage  at  an  early  age,  so 
that  it  may  be  said  through  functional  conditions 
to  pathological  changes  we  are  led  stage  by  stage  to 
the  final  result,  which  cannot  also  but  be  regarded 
as  a  consequence  of  plumbism. 

Lead  or  its  Compounds  in  the  Form  of 
Dust. 

Dust  is  the  agent  most  provocative  of  plumb- 
ism.    All  lead  compounds,  whether  oxide,  chloride,, 

7 


98  LEAD  POISONING 

carbonate,  sulphate,  nitrate,  or  chromate,  are  harm- 
ful. Lead  gains  access  to  the  human  body 
through  the  skin,  by  the  respiratory  organs,  and 
by  the  mouth  and  alimentary  canal.  The  substi- 
tution of  wet  for  dry  methods  of  manufacture  of 
white  lead  has  reduced  the  amount  of  illness 
among  workers  ;  so,  too,  has  abolition  of  hand 
labour  in  the  emptying  of  white  beds  and  in  the 
drying  departments. 

It  is  characteristic  of  lead  poisoning  that  the 
absorption  of  minute  quantities  of  lead  continued 
daily  for  a  few  weeks  or  months  is  not  only 
more  likely  to  produce  symptoms  than  one  or  two 
fairly  large  doses  taken  in  rapid  succession,  but 
that  the  plumbism  which  develops  will  probably 
be  more  severe  and  persistent.  Some  persons  are 
more  prone  to  be  affected  by  lead  than  others. 
There  is  an  individual  and  a  family  predisposition 
to  lead  poisoning.  Women  and  young  persons, 
especially  young  females,  are  more  readily  affected 
by  lead  than  men.  My  experience  leads  me  to 
affirm  not  only  the  greater  susceptibility  of  women 
to  plumbism,  but  also  to  the  worst  types  of  it.  It 
was  on  this  account  that  I  recommended  to  the 
Home  Office  the  abolition  of  female  labour  in  the 
dangerous  processes  of  white  lead  manufacture,  a 
step  which  has  been  followed  by  the  happiest 
results.     Other  circumstances  than  sex  predispose 


LEAD  IN  THE  FORM  OF  DUST  99 

to  plumbism — e.g.,  poverty  and  its  attendant  ills. 
In  my  Goulstonian  Lectures  on  Lead  Poisoning,  I 
drew  attention  to  the  fact  that  men  and  women 
who  commenced  their  daily  work  in  a  lead  factory 
without  taking  food  became  more  readily  affected 
than  those  who  had  breakfasted  before  going  to 
the  factory.  A  simple  breakfast  of  bread  and  hot 
milk,  tea,  or  coffee,  provided  by  the  employer,  is 
one  of  the  best  preventives  of  plumbism  amongst 
his  factory  hands.  Alcoholism  strongly  predis- 
poses to  plumbism.  Intemperate  habits  make 
men  careless  when  at  work  and  less  cleanly  in 
their  habits.  Excessive  indulgence  in  alcohol 
destroys  the  taste  for  food.  Men  addicted  to 
drink  ought  not  to  be  allowed  to  work  in  a  lead 
factory.  In  my  experiments  upon  animals,  I 
found  that  those  which  received  alcohol  in  addi- 
tion to  lead  were  more  readily  poisoned  than  those 
which  received  lead  alone.  From  appearances 
only  it  is  not  always  easy  to  foretell  who  are  the 
persons  most  likely  to  suffer  from  plumbism,  but 
medical  men  whose  function  it  is  to  examine 
applicants  for  work  in  a  lead  factory  do  well  not 
to  accept  anaemic  persons,  those  whose  glandular 
system  is  wrong,  whose  digestion  is  not  normal,  per- 
sons suffering  from  constipation  or  who  have  kidney 
disease.  One  of  the  most  searching  examinations 
of  applicants  for  work  in  a  lead  factory  known  to 


ioo  LEAD  POISONING 

me  is  that  carried  out  by  Dr.  Irvine,  of  Lemington- 
on-Tyne,  at  one  of  the  largest  lead-works  in  New- 
castle-upon-Tyne. After  inquiring  into  previous 
occupation,  the  heart  and  lungs  are  auscultated, 
the  gums  are  carefully  searched  for  possible  traces 
of  a  blue  line,  the  urine  is  tested  for  albumin,  a 
/sphygmogram  is  taken,  and  the  blood-pressure  re- 
corded. It  is  needless  to  say  that  any  man  with 
albuminuria  is  rejected  ;  so,  too,  all  applicants  who 
have  a  blood-pressure  above  140  millimetres  of 
mercury.  To  this  rather  searching  examination 
and  the  weekly  medical  visit  I  attribute  the  re- 
markable freedom  of  the  men  in  this  particular 
factory  from  plumbism. 

In  lead-works,  chewing  and  smoking  of  tobacco, 
especially  cigarette-smoking,  must  be  absolutely 
forbidden.  Men  who  chew  are  apt  when  at  work 
to  draw  out  of  their  waistcoat  pocket  with  their 
soiled  fingers  a  piece  of  tobacco  which  may  or 
may  not  be  coated  with  lead  dust.  Some  work- 
men are  under  the  erroneous  impression  that 
chewing  tobacco  when  at  work  prevents  them 
becoming  lead-poisoned,  but  on  examining  the 
mouth  of  these  men  the  well-marked  blue  line  on 
the  gums,  the  discoloured  teeth,  and  the  unhealthy 
condition  of  the  gums  generally,  do  not  lend 
support  to  this  opinion.  The  abolition  of  the 
use   of  tobacco  in  a  large  white  lead  works  in 


LEAD  IN  THE  FORM  OF  DUST  101 

Nantes  was  followed  by  results  interesting  enough 
to  be  recorded  here.  The  average  number  of  men 
employed  in  the  works  was  670.  In  1902  the 
management  forbade  smoking  for  two  years.  In 
1901  there  had  been  twenty-six  cases  of  lead 
poisoning  in  the  factory,  and  in  1902  the  number 
had  risen  to  forty-two.  The  year  after  smoking  was 
forbidden  there  were  nine  cases  of  plumbism,  and 
in  1904  there  were  only  four  cases.  It  is  not 
claimed  by  the  manager  that  the  improvement  in 
the  health  of  the  men  after  1902  was  entirely  the 
result  of  the  prohibition  of  smoking,  for  some 
minor  improvements  had  been  introduced  in  the 
method  of  drying  the  white  lead ;  but,  taking 
this  and  all  things  into  consideration,  the  manager 
was  disposed  to  regard  the  better  health  of  the 
men  and  their  freedom  from  lead  poisoning  as  the 
result  of  their  abstaining  from  the  use  of  tobacco 
when  at  work.  While  penning  these  notes  I  have 
seen  a  man  twenty-six  years  of  age,  a  mixer  in  a 
glass-works,  with  marked  saturnine  cachexia  and  (V 
well-marked  blue  line  on  his  gums,  who  tells  me 
that  immediately  the  foreman  leaves  the  room  he 
and  his  comrades  remove  their  respirators  and 
smoke  cigarettes.  Wilfulness  added  to  ignorance 
thus  defeats  the  objects  sought  to  be  attained  by 
regulations.  The  employment  of  casual  labour 
should  on  these  grounds  be  discouraged.     Where 


102  LEAD  POISONING 

men  are  regularly  employed  in  a  lead  factory  there 
is  always  less  sickness  among  them  ;  and  although 
some  of  the  workmen  are  not  as  careful  as  they 
ought  to  be,  they  are  yet  more  cleanly  than  casual 
labourers.  In  a  white  lead  factory  there  must 
always  be  a  certain  amount  of  casual  employment, 
for  much  of  the  work  is  unskilled,  the  men  do  not 
stay  long  at  the  work,  and  the  supply  of  labour  is 
not  always  equal  to  the  demand. 

Onset   of   Symptoms,    and   its   Relation    to 
Exposure  to  Lead. 

Since  idiosyncrasy  plays  an  important  part  in 
the  development  of  the  malady,  it  is  impossible  to 
assign  a  date  when  symptoms  of  plumbism  may 
show  themselves  in  persons  exposed  to  lead.  One 
man  may  suffer  from  colic  within  a  fortnight  after 
taking  up  work  in  a  white  lead  factory,  while  his 
comrade  working  alongside  of  him  may  not  suffer 
for  several  months,  or  perhaps  not  at  all.  To 
idiosyncrasy  must  be  added  the  influences  of  such 
personal  qualities  as  cleanliness  and  temperance. 
I  have  seen  a  young  woman  die  from  saturnine 
encephalopathy  ten  weeks  after  taking  up  work  in 
a  white  lead  factory.  One  attack  of  plumbism  pre- 
disposes to  another  ;  but  here  again  idiosyncrasy  is 
an  important  factor,  for  some  men  may  have  one 
attack  of  colic  and  recover,  or  they  suffer  from  loss 


ONSET  OF  SYMPTOMS  103 

of  power  of  the  hands  and  wrists,  and  this  passes 
away,  so  that  the  men  return  to  the  lead  factory 
and  are  able  to  follow  their  occupation  for  years 
without  becoming  ill.  Such  cases  are  not  infre- 
quent ;  they  are  interesting  from  a  recovery  point 
of  view.  In  many  lead  workers  there  is  observed 
a  long  period  of  presaturnism,  extending,  it  may 
be,  over  a  series  of  years,  during  which  the  men 
look  pale  and  their  gums  show  a  well-marked 
blue  line  ;  but  elimination  of  the  metal  apparently 
keeps  pace  with  absorption,  for  lead  is  found  in  the 
urine  and  faeces,  so  that  these  men  continue  to 
follow  their  employment  not  complaining,  and 
yet  not  feeling  quite  well.  Sooner  or  later,  but 
still  without  complaint  of  colic  or  of  loss  of 
muscular  power — sometimes,  too,  without  the  pres- 
ence of  a  blue  line  on  the  gums  —  they  become 
the  subjects  of  ill-health,  the  symptoms  and 
physical  signs  suggest  kidney  disease  and  arterio- 
sclerosis, both  of  which  are  recognized  patho- 
logical effects  of  chronic  plumbism. 

If  we  take  as  the  simplest  type  of  plumbism  the 
case  of  a  person  who  has  drunk  water  contami- 
nated by  lead,  or  a  woman  who  has  taken  diachylon 
pills,  the  symptoms  usually  first  complained  of  are 
severe  abdominal  pain  referred  to  the  neighbour- 
hood of  the  umbilicus,  to  one  or  other  side  of  it, 
pain  of  an  aching  nature,  relieved  by  pressure  in 


104  LEAD  POISONING 

some  instances,  and  in  others  aggravated  by  it. 
The  colic  is  frequently  accompanied  by  vomiting, 
and  usually,  but  not  always,  by  obstinate  con- 
stipation. Abdominal  pain  may  be  the  only 
symptom.  A  few  days  or  weeks  afterwards,  and 
without  necessarily  being  preceded  by  colic,  the 
patient  complains  of  weakness  followed  by  loss  of 
power  in  both  hands  and  wrists.  In  lead  workers 
symptoms  of  plumbism  do  not  always  develop 
quickly.  The  rate  of  poisoning  is  usually  slow. 
Friends  may  have  noticed  and  remarked  upon  the 
increasing  pallor  of  the  face,  or  it  may  be  that  the 
workman  himself  has  complained  of  a  metallic 
taste  in  the  mouth  in  the  morning,  a  disagreeable 
breath,  disinclination  for  food,  recurrent  headache, 
colic,  and  ill-defined  pains  in  the  limbs.  Head- 
ache may  be  the  only  symptom  of  plumbism,  and 
it  is  characteristic  of  the  headache  that  it  is 
extremely  severe. 

Lead  taken  in  drinking  water  is  already  in 
solution,  but  when  swallowed  in  the  form  of 
diachylon  or  as  dust  in  food,  the  compound  has 
first  to  be  dissolved  in  the  gastric  juice  of  the 
stomach  before  it  can  be  absorbed  by  the  mucous 
membrane  and  passed  into  the  blood.  In  a  series 
of  digestion  experiments  carried  out  for  me  by 
Professor  Bedson,  of  the  Armstrong  College,  New- 
castle-upon-Tyne, it  was  found  that  the  gastric 


ONSET  OF  SYMPTOMS  105 

juice  possessed  strong  solvent  powers  over  white 
lead  ;  the  lead  carbonate  became  converted  into 
chloride,  which  is  extremely  soluble  and  dialyzable. 
Lead  chloride  passes  fairly  rapidly  through  animal 
membrane.  Pepsin  alone  had  no  effect  upon 
lead.  The  principal  solvent  in  the  stomach  for 
lead  is  the  dilute  hydrochloric  acid  of  the  gastric 
juice.  Lead  chloride  in  intimate  contact  with 
proteid  becomes  lead  albuminate,  which  is  rather 
an  insoluble  and  indiffusible  substance.  In  the 
digestion  experiments  carried  out  by  Bedson,  it 
was  found  that  if  digestion  of  proteid  food  was 
going  on  at  the  same  time  the  amount  of  lead 
dissolved  was  insignificant.  This  circumstance  is 
of  great  importance  from  the  point  of  view  of  the 
prevention  of  plumbism,  and  is  one  of  the  strongest 
reasons  for  employers  giving  a  free  meal  to  all 
workpeople  before  commencing  work  in  a  lead 
factory  for  the  day.  The  more  recent  experiments 
of  Carlson  of  Chicago  support  my  contention. 
He  found  that  where  lead  is  added  to  gastric  juice 
and  milk,  and  the  mixture  is  incubated  at  body 
temperature  for  ten  hours,  not  enough  lead  goes 
into  solution  to  give  even  a  qualitative  test  of  lead. 
Only  in  two  instances  where  lead  carbonate  paint 
dust  was  used  was  there  a  qualitative  test  of  lead 
obtained.  If  a  fresh  addition  of  hydrochloric  acid 
was  made,  lead  was  dissolved  in  proportion  to  the 


106  LEAD  POISONING 

hydrochloric  acid  added.  The  hydrochloric  acid 
of  the  gastric  juice  is  under  ordinary  circumstances 
fixed  by  the  protein  of  the  milk,  and  neutralization 
is  effected  by  the  alkaline  salts  present  in  the  milk. 
It  is  generally  believed  that  it  is  as  lead  chloride 
that  lead  when  swallowed  passes  into  the  system 
from  the  stomach,  and  one  reason  why  herbivorous 
animals,  such  as  the  rabbit,  are  not  so  rapidly 
brought  under  the  influence  of  lead  as  omnivorous 
animals  may  be  the  relative  deficiency  of  acid  in 
their  gastric  juice. 

Messrs.  Moore,  Oldershaw,  and  Williams,*  are 
of  the  opinion  that,  taking  into  account  the  action 
and  dosage  of  such  a  heavy  metal  as  lead,  the 
relative  development  of  the  intestinal  mucous 
membrane  must  be  considered  when  the  question 
of  absorption  is  being  dealt  with.  In  such  om- 
nivorous animals  as  cats  and  dogs,  heavy  metals 
are  far  more  toxic  proportionally  than  they  are  in 
herbivorous  animals,  owing  to  the  shorter  intes- 
tine of  the  omnivor.  As  lead  under  these  circum- 
stances tends  to  accumulate  in  the  intestine, 
death  occurs  during  the  process  of  elimination. 
According  to  these  writers,  the  intestinal  mucous 
membrane  is  to  be  regarded  as  a  path  of  elimina- 
tion rather  than  of  absorption.  It  is  to  be  remem- 
bered that  this  remark  applies  to  lead  which  was 
*  British  Medical  Journal,  August  2,  1913. 


ONSET  OF  SYMPTOMS  107 

introduced  into  the  system  by  hypodermic  ad- 
ministration, and  not  by  the  mouth.  Lead 
administered  hypodermically  behaves  like  the  ions 
of  other  heavy  metals  ;  it  is  eliminated  by  the 
intestinal  mucous  membrane,  and  in  its  excretion 
it  causes  irritation  and  congestion  of  the  mem- 
brane ;  but  it  is  otherwise  when  lead  is  swallowed, 
for  digestion  of  the  metal  is  completed  within  the 
alimentary  canal  itself,  and  absorption  takes  place 
from  it.  Where  a  soluble  salt  of  lead  unites  with 
proteid  it  forms  an  insoluble  albuminate,  in  which 
it  has  generally  been  held  that  the  lead  is  simply 
retained  mechanically  in  the  albumin,  but  this  is 
not  the  opinion  come  to  byT.  M.  Clague  and  my- 
self as  the  result  of  experiment.  If  such  a  sub- 
stance is  present  in  blood,  a  fluid  rich  in  chloride, 
Moore  holds  that  the  lead  may  become  reconverted 
into  a  soluble  chloride  in  the  presence  of  the  con- 
tained sodium  chloride.  In  this  form  it  would 
readily  circulate  through  the  body  and  pass  out 
by  the  kidneys.  Legge  and  Goadby  are  of  the 
opinion  that,  as  lead  particles  are  taken  up  by 
leucocytes,  in  whose  interior  the  lead  becomes 
converted  into  peptonate  or  albuminate,  the  lead 
is  probably  eliminated  through  the  kidney  in  this 
colloidal  form.  Lead  leaves  the  body  in  larger 
quantities  by  the  faeces  than  by  the  urine.  After 
the   administration  of   lead   salts    by   the    mouth, 


108  LEAD  POISONING 

Carlson  found  that  63  per  cent,  of  the  lead  given 
as  carbonate,  and  95  per  cent,  as  sulphate,  escaped 
by  the  fasces. 

When  carrying  out  for  me  a  series  of  digestive 
experiments,  Professor  Bedson  found  that  bile 
dissolved  three  times  more  lead  than  gastric  juice. 
Pancreatic  juice  rather  hindered  than  encouraged 
the  solution  of  lead.  During  pancreatic  digestion 
alone  no  lead  was  dissolved  in  most  of  the  experi- 
ments. Bedson's  experiments  were  made  with  lead 
carbonate.  It  has  been  claimed  by  some  writers 
that  lead  sulphate,  owing  to  its  lesser  degree  of 
solubility  in  the  gastro-intestinal  juices,  is  less 
harmful  to  persons  working  in  it  than  is  lead 
carbonate.  Goadby  is  not  of  this  opinion.  He 
found  that,  while  0*048  and  0*042  per  cent,  of  lead 
carbonate  were  dissolved,  the  quantities  for  lead 
sulphate  were  0*080  and  0*046. 

Ur.  Alice  Hamilton*  gives  a  series  of  digestion 
experiments  which  were  carried  out  in  the  Hull 
Physiological  Laboratory  of  Chicago  University 
by  Messrs.  A.  J.  Carlson  and  A.  Woelfel.  Goadby, 
as  the  result  of  his  experiments,  was  led  to  regard 
lead  sulphate  as  more  soluble  in  gastric  juice  than 
lead  carbonate  ;  but  Carlson,  also  making  use  of 
human  gastric  juice,  found   on   an    average  1*12 

*  "  Hygiene  of  the  Painters'  Trade,"  Bureau  of  Laboui 
Statistics,  Bulletin  120.     Washington,  1913. 


ONSET  OF  SYMPTOMS  109 

grains  of  lead  carbonate  dissolved  for  0*97  of  basic 
lead  sulphate.  Carlson  states  that  the  greater 
solubility  of  lead  sulphate  in  the  gastric  juice  is  a 
chemical  impossibility.  It  is  hardly  necessary  to 
remind  readers  that  it  is  the  hydrochloric  acid  of 
the  gastric  juice  which  is  the  principal  solvent  of 
lead  salts.  The  Chicago  Professor  took  basic  lead 
sulphate  paint  dust,  also  basic  lead  carbonate 
paint  dust,  and  he  found  that  gastric  juice  dis- 
solved 9*5  per  cent,  of  the  sulphate  and  46*1  per 
cent,  of  carbonate.  In  a  series  of  three  experi- 
ments with  human  gastric  juice,  he  found  that 
0*1235  gramme  of  lead  sulphate  was  dissolved, 
equivalent  to  24  per  cent. ;  that  in  gastric  juice 
with  peptone  0*1330,  or  26  per  cent.,  was  dissolved; 
whereas  with  lead  carbonate  the  amounts  were 
0*2992  gramme,  or  59'S  per  cent.,  and  in  the 
peptone  experiment  64  per  cent.  Instead  of  lead 
sulphate  being  more  readily  dissolved  in  gastric 
juice,  Carlson  found  the  carbonate  to  be  twice 
more  soluble  than  the  sulphate. 

In  my  own  experiments  I  found  lead  carbonate 
to  be  more  toxic  than  sulphate.  Goadby  found 
cats  more  readily  poisoned  by  lead  sulphate  than 
by  carbonate.  Blum,  on  the  other  hand,  found 
sulphate  of  lead  to  be  less  poisonous  than  the 
carbonate.  Carlson  administered  lead  sulphate 
paint  dust  and  basic  lead  carbonate  paint  dust  in 


no  LEAD  POISONING 

meat  to  dogs,  and  he  found  that  the  dogs  which 
received  lead  carbonate  paint  dust  developed  severe 
symptoms  of  lead  poisoning  within  twenty-four  to 
forty-eight  hours  after  the  first  feeding ;  whereas 
dogs  fed  upon  sulphate  paint  dust  did  not  show 
symptoms  of  poisoning  until  after  three  to  four 
feedings,  or  from  seventy-two  to  ninety-six  hours 
afterwards.  Cats  were  exposed  to  a  similar 
ordeal,  with  the  result  that  lead  carbonate  and  lead 
carbonate  paint  dust  were  found  by  Carlson  to  be 
more  distinctly  poisonous  than  basic  lead  sulphate 
and  lead  sulphate  paint  dust.  I  have  given  the 
details  of  these  experiments  owing  to  the  contro- 
versial opinions  expressed  by  various  writers  in 
regard  to  the  comparative  toxic  values  of  lead 
carbonate  and  lead  sulphate. 

Experiments  upon  animals  have  helped  to 
solve  some  of  the  problems  connected  with  lead 
poisoning.  Animals  are  not  all  alike  in  their 
behaviour  towards  lead,  nor  are  human  beings. 
Some  are  more  susceptible  than  others.  As 
regards  animals,  dogs  and  cats  are  readily  brought 
under  the  influence  of  lead,  but  rats,  especially 
wild-rats,  also  rabbits,  are  not  so  quickly  in- 
fluenced. Whether,  as  regards  the  rat,  owing  to 
the  long  association  of  his  race  with  the  metal, 
and  the  comparative  ease  with  which  the  animal 
can  gnaw  through  lead  pipes  without  suffering,  a 


ONSET  OF  SYMPTOMS  in 

kind  of  immunity  to  plumbism  has  been  developed, 
I  am  not  prepared  to  say.  Rabbits,  on  account  of 
being  vegetable  feeders,  may  on  that  account  be 
more  resistant  than  other  animals.  One  of  my 
laboratory  rabbits  took  lead  almost  daily  for  three 
years.  During  that  period  it  received  by  pipette 
1,095  grains  of  nitrate  of  lead,  equivalent  to 
684  grains  of  metallic  lead.  Usually  one  attack 
of  plumbism  predisposes  to  another.  Long  con- 
tact with  the  metal  does  not  necessarily  confer 
immunity.  Lead  is  unlike  many  poisons.  There 
can  be  no  trifling  with  it.  I  have  known  men  who 
had  worked  in  a  lead  factory  for  thirty  years 
without  suffering  from  plumbism,  yet  become  ill 
after  such  a  long  term  of  service. 

Dr.  Walter  Straub  of  Freiburg  has  recently* 
suggested  a  method  of  inducing  lead  poisoning  in 
animals  which  several  years  ago  I  had  made  use 
of.  He  injected  under  the  skin  of  the  back  of  a 
rabbit,  on  September  1,  1908,  a  quantity  of 
freshly-precipitated  lead  carbonate.  On  Novem- 
ber 7  the  animal  appeared  to  be  quite  well. 
Subsequently  there  slowly  developed  paralysis  of 
the  fore- limbs,  and  a  few  days  afterwards  the  hind- 
limbs  became  the  seat  of  spastic  paraplegia.  The  1/ 
muscles  affected  were  mostly  the  abductors.  The 
paralysis  continued  until  the  death  of  the  animal. 

*  Munchener  Medizin.  Wochenschrift,  January  6,  1914. 


112  LEAD  POISONING 

The  animal  died  on  January  30,  igog — i.e.,  124 
days  after  receiving  the  lead — without  having  lost 
weight  and  without  its  appetite  having  been  im- 
paired. At  the  post-mortem  examination  of  the 
body  a  considerable  quantity  of  unabsorbed  lead  was 
found  at  the  site  of  the  injection.  Cats  similarly 
treated  died  within  seven  to  twelve  weeks  after 
the  injection,  from  bulbar  paralysis,  and  with 
a  distinct  loss  of  body-weight.  Erlenmeyer,  who 
was  associated  with  Straub,  has  given  a  good 
description  of  plumbism  in  cats.  Aschoff  found, 
on  microscopical  examination,  structural  changes 
in  the  spinal  medulla,  but  not  in  all  the  animals. 
In  one  there  was  marked  cellular  infiltration  of 
Goll's  and  Burdach's  columns.  Professor  H. 
Schridde  examined  the  blood  of  one  of  the  cats 
before  it  died,  but  failed  to  find  evidence  of  baso- 
philia. The  pathological  findings  are  interesting, 
for  bulbar  symptoms  are  extremely  rare  in  man. 
While  in  some  of  Straub's  animals  which  showed 
signs  of  plumbism  a  large  quantity  of  lead 
remained  unabsorbed,  others  in  whom  all  the  lead 
had  been  absorbed  did  not  show  any  symptoms  of 
plumbism  at  all.  The  amount  of  lead  absorbed 
during  the  eight  to  ten  weeks  the  animals  lived 
varied  from  o'i  to  0*2  gramme,  a  small  quantity 
admittedly,  but  it  is  common  knowledge  that  it  is 
the  absorption  of  minute  quantities  of  lead  which 


CHANNELS  OF  ENTRANCE  OF  THE  POISON    113 

gives  rise  to  symptoms.  Straub  therefore  regards 
o*3  gramme — i.e.,  5  grains — of  lead  as  capable  of 
inducing  plumbism. 

Channels  of  Entrance  of  the  Poison. 

Considering  the  frequent  opportunities  offered 
to  lead  to  enter  the  body  by  the  skin,  this  surface 
cannot  be  regarded  as  a  common  mode  of  entrance, 
and  yet  serious  symptoms,  and  even  fatal  results, 
have  followed  the  application  of  lead  externally. 
Wrist-drop  is  met  with  in  men  who  cut  leather  on 
lead  slabs.  This  may  partly  be  the  result  of 
friction  of  the  hand  against  the  lead  slab  causing 
the  dust  to  penetrate  the  moist  skin,  or  it  may  be 
the  result  of  the  inhalation  of  fine  particles  of 
oxide  of  lead  which  come  from  the  slab.  Tanc- 
querel  des  Planches  tells  us  that  in  the  Paris 
hospitals  colic  was  never  known  to  have  followed 
the  application  of  lead  to  the  skin  This  is  not 
my  experience.  I  have  treated  an  actress  for 
colic,  headache,  and  amaurosis  with  haemorrhages  IS 
into  the  retina,  due  to  the  use  of  cosmetics,  and 
the  reason  why  symptoms  do  not  more  frequently 
follow  the  use  of  cosmetics  containing  lead  may  be 
that  the  fat  in  the  paste  blocks  the  pores  of  the  skin. 
^Hair-dyes  which  contain  lead  have  caused  serious 
symptoms,  while  their  use  in  one  instance  to  my 


■91' 


H4  LEAD  POISONING 

knowledge  caused  death.  Dr.  G.  B.  Morgan,  of 
Sunderland,  informs  me  that  he  was  consulted  by 
a  maiden  lady,  seventy-two  years  of  age,  on 
account  of  a  drooping  of  the  left  upper  eyelid, 
double  vision,  muscular  pains,  severe  headache, 
increasing  feebleness,  and  constipation.  In  addi- 
\J  tion  both  arms  were  paretic,  and  there  was  diver- 
gent squint  of  the  left  eye.  A  week  afterwards, 
as  there  was  no  improvement  in  the  symptoms, 
Dr.  Morgan  ordered  7  grains  of  potassium  iodide 
to  be  added  to  each  dose  of  the  medicine.  On  the 
following  day  the  lady  was  found  dead  in  bed. 
At  the  post-mortem  examination  nothing  was 
found  in  the  brain  or  in  any  part  of  the  body  to 
explain  the  symptoms  and  death.  Two  medical 
men  who  were  present  at  the  autopsy  remarked 
upon  the  beautiful  black  hair  of  such  an  old 
woman.  Two  weeks  afterwards  a  niece  called 
upon  Dr.  Morgan,  and  gave  him  some  powders 
which  she  had  found  in  her  aunt's  chest  of 
drawers.  On  analysis  these  were  found  to  contain 
acetate  of  lead  and  sulphur.  There  was  not  the 
least  doubt  that  the  powders  were  used  to  dye  the 
hair,  and  that  the  illness  which  developed  was  a 
consequence  of  their  use.  The  iodide  of  potas- 
sium had  redissolved  lead  which  was  lying  in  an 
insoluble  form  in  the  body  and  caused  the  rapidly 
fatal  toxaemia. 


CHANNELS  OF  ENTRANCE  OF  THE  POISON    115 

Notwithstanding  the  above,  the  skin  remains  an 
uncommon  mode  of  entrance  of  lead  into  the  body. 
It  is,  however,  a  surface  by  which  lead  may  be 
eliminated  from  the  body.  In  some  of  my 
hospital  patients  Professor  Bedson  found  lead  in 
the  perspiration. 

Lead  enters  the  body  by  the  respiratory  organs 
and  passages.  Men  when  working  in  the  dusty 
atmosphere  of  a  white  lead  factory  cannot  but 
inhale  dust.  Most  of  this  is  caught  in  the  naso- 
pharynx and  is  swallowed,  but  some  of  the  finer 
particles  are  carried  onwards  by  the  inspired  air 
into  the  lungs.  In  whatever  part  of  the  respira- 
tory passages  lead-dust  becomes  deposited,  it  is 
brought  under  the  influence  of  moisture  and  heat. 
The  fluids  secreted  are  alkaline,  and  as  carbonic 
acid  is  passing  to  and  fro  over  the  surface  during 
inspiration  and  expiration,  the  lead  carbonate  is 
probably  converted  into  bicarbonate,  dissolved  and 
absorbed.  Several  years  ago  Alderson  drew  atten- 
tion to  absorption  of  lead  by  the  respiratory  organs 
as  likely  to  induce  more  serious  symptoms  than 
when  lead  was  introduced  into  the  body  by  other 
channels.  Goadby,*  as  the  result  of  experi- 
ment, has  arrived  at  a  similar  opinion  :  he  main- 
tains that  "  lead-dust  circulating  in  the  air  is 
many   times  more  dangerous  than  lead  actually 

*  "  Lead  Poisoning  and  Lead  Absorption,"  p.  98. 


n6  LEAD  POISONING 

swallowed."  The  amount  of  lead-dust  which 
reaches  the  lungs  by  inhalation  must  be  small. 
The  plumbism  which  follows  inhalation  of  lead- 
dust  may  therefore  be  due  not  to  lead  having 
reached  the  lung,  but  caught  in  the  mouth  and 
throat  or  on  any  portion  of  the  respiratory 
passages.  That  fine  particles  of  lead  carbonate 
can  reach  the  lung  there  is  no  doubt.  Laborde 
found  that  guinea-pigs  exposed  to  an  atmosphere 
in  which  white  lead  dust  was  suspended  died 
within  two  hours,  and  that  in  the  lungs  there 
were  small  haemorrhages,  probably  the  result  of 
irritation.  On  the  other  hand,  Professor  K.  B. 
Lehmann  of  Wurzburg  and  his  assistant  Saito, 
notwithstanding  the  fact  of  the  respiratory 
passages  being  the  channel  of  entrance  of  the  dust, 
found  that  only  12  per  cent,  of  the  lead  reached 
the  lungs,  and  that  70  per  cent,  was  found  in  the 
alimentary  canal.  While  penning  these  notes  I 
examined,  as  stated  earlier,  two  men  employed  in 
mixing  red  lead,  salt-cake,  and  sand  in  a  glass 
works.  On  the  occasion  of  my  visit  they  were 
wearing  respirators,  but  they  had  evidently  been 
just  affixed,  for  on  examining  the  mouth  of  one  of 
the  men  who  had  only  been  a  fortnight  in  the 
works,  and  who  was  ignorant  of  the  risk  he  was 
running,  I  found  a  well-marked  blue  line  on  the 
gums,    and  in   the   other  man,  who  had   worked 


CHANNELS  OF  ENTRANCE  OF  THE  POISON    117 

four  weeks  in  the  factory,  there  was  not  only  a 
deep  blue  line  on  both  gums,  but  on  the  teeth  a 
bright  red  deposit  of  fine  granules  of  the  oxide  of 
lead.  These  men  were  breathing  an  atmosphere 
which  contained  red  lead  dust,  and  while  possibly 
some  of  it  reached  the  lungs,  the  bulk  of  it  was 
being  caught  on  the  teeth  and  in  the  mouth, 
where  it  would  become  dissolved  in  the  saliva  and 
swallowed. 

Admitting  that  the  lungs  and  the  respiratory 
passages  are  frequent  channels  of  entrance  of  lead 
into  the  system,  I  am  of  the  opinion  that  it  is 
by  the  alimentary  canal,  even  when  lead  has 
primarily  reached  the  upper  part  of  the  respiratory 
passages,  that  most  of  the  poison  enters  the  body. 
Reaching  the  stomach,  it  is  acted  upon  by  the 
hydrochloric  acid  of  the  gastric  juice,  whereby  it  is 
rendered  soluble,  and  is  absorbed  unless  proteid 
food  is  being  digested  at  the  same  time,  when  only 
minute  quantities  of  lead  will  be  absorbed,  the 
bulk  of  the  poison  being  thrown  out  in  the  faeces. 
Soluble  lead  salts  readily  pass  through  any  portion 
of  the  alimentary  canal  by  osmosis  into  the  veins, 
by  which  they  are  carried  to  the  liver.  This  1/ 
circumstance  partly  explains  the  fact  of  the  liver 
containing  considerable  quantities  of  lead  after 
death.  The  following  histories  and  tables  taken 
from  my  Goulstonian  Lectures  show  the  amounts 


n8  LEAD  POISONING 

of  lead  which  Professor  Bedson  found  in  the 
internal  organs  of  some  of  my  infirmary  patients 
who  died  from  plumbism. 

Elizabeth  T.,  aged  22,  single,  had  worked  off  and 
on  during  two  and  a  half  years  in  a  white  lead 
factory.  At  the  end  of  the  first  three  months  she 
had  to  give  up  work  on  account  of  colic.  On 
subsidence  of  the  pain  she  returned  to  the  factory, 
and  worked  seven  weeks,  when  she  was  again 
obliged  to  desist  on  account  of  colic.  Eleven 
months  previously  to  coming  under  my  care  she 
had  suffered  from  severe  headache,  followed  by 
partial  blindness.  At  this  period  she  remained 
away  from  the  factory  for  two  months.  On 
returning  to  work  she  again  suffered  from  head- 
ache, also  from  pains  in  her  joints,  and  her 
eyesight  became  worse.  Urine  was  free  from 
albumin.  At  the  time  of  admission  to  the 
infirmary  patient  was  menstruating.  Patient 
died  in  a  convulsion  the  day  after  being  admitted. 
At  the  autopsy  there  was  observed  a  blue  line  on 
the  gums.  The  lungs  were  healthy;  heart  weighed 
10^  ounces,  the  wall  of  the  left  ventricle  was 
slightly  thickened,  the  valves  were  healthy,  also 
the  endocardium  ;  liver  and  spleen  were  healthy. 
From  the  pelvis  of  the  right  kidney  there  escaped 
a  few  drops  of  a  purulent-looking  fluid,  but  there 


CHANNELS  OF  ENTRANCE  OF  THE  POISON    119 

was  no  injection  of  the  lining  membrane,  and  the 
kidney  substance  generally  appeared  to  be  healthy, 
so  too  that  of  the  left  kidney.  The  interior  of 
the  uterus  was  covered  with  sanious  material, 
probably  menstrual.  On  examining  the  brain,  the 
subarachnoid  fluid  was  found  to  be  excessive  in 
the  interpeduncular  space  and  around  the  pons. 
The  cerebellum  was  pale  compared  with  the 
cerebrum.  The  surface  of  the  brain  was  healthy, 
and  the  vessels  were  not  unduly  injected.  On 
section  the  brain  tissue  was  generally  pale  ;  there 
were  few  puncta  hemorrhagica ;  two  to  three 
drachms  of  serum  in  the  lateral  ventricles ;  the 
spinal  cord  was  pale  and  hard. 

Case  of  Elizabeth  T. 


Total  Lead  in 

Weight  of 
Organ. 

Grains  of  Lead 

Name  of  Organ. 

Parts  per 

per  Weight 

Million. 

of  Organ. 

Ounces. 

Lung  ' 

7-6 

29-0 

0*0964 

Heart  ... 

4-12 

IO-5 

0*0189 

Liver  ... 

37-8 

60-5 

I'OOO 

Spleen 

I2T> 

6'5 

0-0341 

Kidneys 

IO"0 

5-25 

0-0229 

Cerebrum 

9-8  | 

24-8$ 

Cerebellum    ... 

5i*5 

0779 

Pons 

22*6 

— 

■ — 

Spinal  cord    ... 

ri6 

— 

— 

Large  intestine 

377 

— 

— 

LEAD  POISONING 


. 

pi        i/i 

2     « 

j*    g 

Bi 

X  a  S 

•See 

tJcE 

TJ  E 

"S  s 

i2  c 

Name  of 
Organ. 

lolic  E 
Lead  i 
ligram 

real  E 
Lead  i 
ligram 

ous  E: 
Lead  i 
ligram 

TO    C 

-  b/J 

<u  E 

TO.  2 

<u      rz 

">  ^ 

Si     § 

< 

<s 

H2 

Pons   ... 

0*14 

°'35 

o"o 

6-i 

o"59 

22"6 

Cerebel- 

lum ... 

0-25 

°'4 

o-o 

i"iS 

r8o 

24-8 

Cere- 

brum 

o-3 

o-o 

O'O 

i-35 

1-65 

9-8 

The  largest  amounts  of  lead  were  found  in  the 
liver,  large  intestine,  cerebellum,  and  pons. 
There  is,  however,  no  uniformity  in  regard  to  the 
distribution  of  lead  in  the  internal  organs,  as  the 
following  table  shows : 

Case  of  Cath.  H. 


Total  Lead  in 

Weight  of 
Organ. 

Grains  of  Lead 

Name  of  Organ. 

Parts  per 
Million. 

on  Total  Weight 
of  Organ. 

Ounces. 

Heart 

0"5 

7-5 

(TOO  1 6 

Liver  

41-6 

45'o 

0-819 

Kidneys 

i3'3 

4'5 

0*0261 

Spleen 

39-0 

5'o 

— 

Cerebrum 

2I"6 

— 

— 

Cerebellum    ... 

8-59 

— 

— 

Cerebrum  and 
Cerebellum 

}      30-19 

48-0 

0-634 

CHANNELS  OF  ENTRANCE  OF  THE  POISON   121 


0 

nj         to 

0      • 

ract, 

es. 

.£  8 

— '    cj 

^cE 

;sE 

x  e  S 

•C    B 

■si 

2  C 

Name  of 
Organ. 

Icoholic  It 

Lead  i 

Milligram 

thereal  E 

Lead  i 

Milligram 

queous  E 

Lead  1 

Milligram 

J   I 

a;  £ 

OS 

H2 

&1 

•oil 

a 
.J 

< 

W 

< 

Brain  ... 

o-6 

0-6 

091 

1 '3 

3-4I 

21-6 

The  liver,  spleen,  and  brain  of  Cath.  H. 
contained  the  largest  amounts  of  lead.  In  the 
brain  of  one  of  my  patients  Professor  Bedson 
found  the  equivalent  of  4*04  milligrammes  of 
metallic  lead,  and  in  the  brain  of  another  3*41. 
Mr.  Wynter  Blyth  on  one  occasion  recovered  from 
the  human  cerebrum  997  milligrammes  of  sulphate 
of  lead,  and  from  the  cerebellum  I7"4-  Gowers  in 
his  "Medical  Ophthalmoscopy"  mentions  a  case 
of  x\tkinson's  in  which  5  grains  of  lead  were  found 
in  the  brain. 

The  following  table  represents  in  milligrammes 
the  amount  of  lead  found  in  the  organs  of  rabbits 
to  whom  lead  carbonate  had  been  given  in  food : 


A. 

M. 

s- 

J- 

Muscle 

O'OJ 

Liver      

0-15 

o"°5 

Trace 

Small  intestine... 

. — 

— 

Stomach 

— 

0*04 

— 

— 

Heart     

— 

— 

■ — 

— 

Brain 

0-02 

— 

— 

— 

Large  intestine 

— 

— 

— 

— 

Kidney  ... 

Trace 

— 

— 

122  LEAD  POISONING 

In  the  case  of  rabbit  M,  which  died  from  rupture 
of  a  pregnant  uterus,  it  is  interesting  to  note  that 
while  lead  was  practically  absent  in  her  tissues,  it 
was  present  to  the  extent  of  o#i  milligramme  in 
the  liquor  amnii,  and  to  the  extent  of  o*og  in  each 
of  the  five  foetuses  found  in  her  uterus. 


Symptomatology. 

One  of  the  earliest  signs  of  lead  intoxication  is 
pallor.  The  face  is  not  only  pale  but  sallow. 
Fresh-coloured  persons  soon  lose  their  ruddiness 
when  working  regularly  in  lead.  Their  facial  ex- 
pression, too,  becomes  altered.  The  blood  becomes 
pale,  thin,  and  watery,  and  the  red  corpuscles  are 
diminished  in  number.  Instead  of  there  being 
5  million  red  corpuscles  per  cubic  millimetre  of 
blood,  they  fall  to  3!  million  or  less.  The  white 
corpuscles  do  not  exhibit  such  aberration  in 
numbers.  By  some  lead  workers  the  facial  fulness 
and  the  body-weight  are  retained,  but  in  others 
there  is  loss  of  flesh,  which  is  slowly  progressive 
up  to  a  certain  point,  after  which  the  bodily 
equilibrium  is  steadily  maintained,  it  may  be  for 
months  or  years,  without  symptoms  of  plumbism. 
With  the  reduction  in  the  number  of  red  blood  cor- 
puscles the  amount  of  haemoglobin  correspondingly 
falls. 


THE  BLOOD  IN  SATURNINE  POISONING     123 

The  Blood  in  Saturnine  Poisoning. 

Medical  opinion  is  divided  upon  the  point  of  the 
anaemia  of  plumbism  being  the  result  of  an  active 
destruction  of  red  blood  corpuscles  or  of  a  lessened 
production.  The  somewhat  pale  urine  passed  in 
plumbism  suggests  deficient  production  of  red 
blood  corpuscles  rather  than  a  destruction  of  them. 
That  the  intracellular  contents  of  red  corpuscles  are 
altered  is  shown  by  the  punctated  appearance  pre- 
sented by  several  of  the  erythrocytes  when  stained 
by  certain  reagents.  Romanowsky's  stains  bring 
into  prominence  basophilia  if  it  is  present.  In  baso- 
phile  degeneration  a  few  of  the  erythrocytes  show 
numerous  minute  bluish-black  specks.  The  blood 
alteration  to  which  Grawitz*  and  others  have 
drawn  attention  is  regarded  by  some  physicians 
as  a  sign  of  importance  in  the  diagnosis  of  lead 
poisoning.  Before  Grawitz  drew  attention  to  this 
subject  Ehrlich,  in  1880,  had  written  upon  baso- 
philia in  plumbism.  As  basophilia  is  not  always 
present,  even  in  cases  of  lead  poisoning  which  are 
beyond  question,  and  since,  too,  it  is  met  with  in 
diseased  conditions  which  have  no  reference 
whatever  to  lead,  the  sign  is  thus  to  some  extent 
shorn  of  much  of  its  value.     It  is  maintained  that 

*  La  Semaine  Medicate,  1900,  p.  40;  also  "  Klinischer 
Patholog.  des  Blutes,"  p.  86. 


124  LEAD  POISONING 

if  basophile  red  corpuscles  are  present  in  a  film  of 
blood  to  the  extent  of  over  ioo  per  million  of  red 
corpuscles,  this  is  positive  proof  of  the  existence 
of  lead  poisoning.  M.  J.  Schonfeld  *  states  that  by 
the  detection  of  basophilia  alone  he  is  able  to  place 
according  to  risk  the  various  occupations  which 
expose  the  workers  to  saturnism.  He  does  so  in 
the  following  order  :  colour  lithography,  type 
founding,  colour  mixing,  house  painting,  electro- 
accumulator  making,  file  cutting,  metal  polishing, 
and  stereotyping.  Compositors  follow  closely 
upon  the  latter.  Of  185  compositors,  Schonfeld 
found  that  only  20  gave  a  positive  reaction. 
Dealing  with  this  subject,  he  makes  the  following 
remark  :  While  compositors  are  the  victims 
of  plumbism  in  small  numbers,  the  men  are  so 
preoccupied  with  their  symptoms  that,  owing  to 
their  nervous  tension,  when  the  slightest  illness 
develops  there  is  created  in  them  a  condition 
bordering  upon  saturnine  hysteria,  so  that  they 
consult  a  doctor  with  their  diagnosis  of  lead 
poisoning  self-made.  Schonfeld  therefore  regards 
a  negative  basophilia  in  compositors  as  most 
important,  for  he  makes  use  of  the  fact  to  en- 
courage the  men  that  they  are  not  suffering  from 
plumbism.  This  writer  omits  from  his  classifica- 
tion of  trades  likely  to  give  rise  to  plumbism  lead 

*  Medizinische  Klinik,  May  18,  1913. 


THE  BLOOD  IN  SATURNINE  POISONING     125 

smelting,  the  cleaning  of  flues,  and  the  manufac- 
ture of  red  and  white  lead.  Possibly  he  was  not 
so  favourably  situated  as  to  have  the  opportunity 
of  observing  the  harmful  effect  of  these  trades. 
Professors  Hoffman  and  Schmidt  of  Leipsic, 
maintain  that  the  presence  of  100  basophile 
erythrocytes  per  million  red  blood  corpuscles  in 
the  blood  of  a  person  working  in  lead  ought  to  be 
occasion  for  the  factory  doctor  to  watch  such  a 
workman  from  a  health  point  of  view,  and  that  any 
person  whose  blood  showed  300  per  million  should 
be  at  once  suspended  from  work  in  lead.  This 
opinion  has  been  accepted  by  the  authorities  in 
Leipsic  and  by  the  State  as  the  basis  upon  which 
suspension  from  work  should  be  enforced.  At 
the  Institute  of  Hygiene,  Leipsic,  1,031  blood 
examinations  were  made  between  the  years  1907 
and  1912.  Basophilia  was  found  in  187  instances 
— i.e.,  in  18*1  per  cent.  Dr.  John  Russell  *  in  100 
consecutive  examinations  of  persons  receiving 
compensation  for  lead  poisoning  in  the  Stoke-on- 
Trent  area  found  that  27  exhibited  no  blood 
changes,  26  showed  basophilia  under  300  per 
million,  and  that  47  showed  granular  degeneration 
ranging  from  300  to  27,000  per  million.  It  is  to 
be  remembered  that  in  other  pathological  con- 
ditions such  as  nitrobenzene  and  aniline  poisoning, 
*  British  Medical  Journal,  January  7,  1914,  p.  143. 


126  LEAD  POISONING 

and  in  some  forms  of  bloodlessness  such  as  per- 
nicious anaemia  and  malaria,  basophilia  may  be 
present,  and  that  it  is  occasionally  present  in  the 
blood  of  healthy  persons  who  have  not  been  brought 
into  contact  with  lead  (Teleky). 

It  would  be  idle,  in  face  of  the  strong  evidence 
thus  advanced,  to  attempt  to  depreciate  the  extent 
or  the  meaning  of  basophilia  in  plumbism.  In  the 
North  of  England  basophilia  is  not  so  frequently 
met  with  in  lead-poisoned  persons,  as  in  the  Mid- 
lands, London,  and  on  the  Continent.  In  some  of 
my  patients  the  degeneration  has  been  detected  by 
means  of  the  various  aniline  stains  recommended  by 
writers  upon  the  subject,  but  in  by  far  the  majority 
of  cases — at  least  75  per  cent. — it  is  absent.  The 
greatest  care  has  been  taken  in  the  preparation, 
staining,  and  examination  of  the  blood  films. 
These  films  have  been  examined  by  competent 
pathologists,  not  only  in  the  North  of  England, 
but  elsewhere  by  pathologists  of  repute,  with  the 
result  that  even  in  the  blood  of  well-marked  cases 
of  plumbism  basophilia  was  not  found.  For  these 
and  other  reasons  basophilia  has  not  to  me  the 
diagnostic  importance  which  several  British  and 
Continental  physicians  claim  for  it. 

Ludwig  Teleky*  of  Vienna  has  reviewed  this 

*  "  Die  Arztliche  Uberwachung  und  Begutachtung  in 
der  Bleitrieben  beschaf  tigten  Arbeiter."  Berlin  :  A.  Seydel, 
1912. 


THE  BLOOD  IN  SATURNINE  POISONING     127 

subject  at  considerable  length.  In  addition  to 
Grawitz,  Messrs.  Behrend,  Hamel,  Moritz,  and 
Embden  maintain  that  basophilia  is  one  of  the 
first  diagnostic  signs  of  plumbism,  and  that  it  is 
present  in  workmen  who  have  not  yet  begun  to 
complain  of  symptoms  of  plumbism.  P.  Schmidt, 
in  drawing  the  line  between  normal  and  patho- 
logical basophilia,  says  that  if  100  punctated 
erythrocytes  per  million  red  corpuscles  are  present, 
upon  this  circumstance  alone  a  diagnosis  of 
plumbism  may  be  made,  and  that  by  detecting 
the  malady  in  this  early  stage  the  more  serious 
forms  of  lead  intoxication  may  be  averted.  Per- 
sonally, I  could  hardly  recommend  the  suspension 
from  work  in  a  lead  factory  of  any  person  whose 
erythrocytes  showed  basophile  granules.  Baso- 
philia is  not  of  itself  a  disabling  circumstance. 
Lutoslawsky,  in  1902,  found  in  107  persons  suffer- 
ing from  chronic  plumbism  only  17  in  whom 
there  was  no  basophilia.  On  the  other  hand, 
Biondi,  at  the  1906  Congress  of  Industrial 
Diseases,  Milan,  stated  that  he  had  not  found 
basophile  red  corpuscles  in  the  blood  of  persons 
suffering  from  severe  lead  intoxication. 

In  order  to  determine  the  value  of  basophilia  in 
plumbism  from  a  diagnostic  point  of  view,  Teleky 
submitted  the  matter  to  the  following  test.  Secur- 
ing the  assistance  of  Dr.  Alfred  Gotzl,  it  was 
arranged  that  an  examination  of  the  blood  of  all 


128  LEAD  POISONING 

persons  coming  to  Dr.  Teleky  suffering  from  lead 
poisoning  was  to  be  made,  the  agreement  being 
that  Teleky  was  to  take  a  note  of  the  history  of 
each  patient,  to  prepare  the  film  of  blood,  and  to 
make  a  diagnosis  without  knowing  what  a  micro- 
scopical examination  of  the  stained  blood  revealed. 
Gotzl  was  to  examine  the  films  for  basophilia,  and 
only  after  he  got  his  results  together  was  he  to  be 
informed  of  the  history  of  the  cases.  In  this  way 
Gotzl's  examination  was  purely  objective.  The 
blood  was  taken  on  the  occasion  of  the  first  visit 
of  the  patient  to  Professor  Teleky,  and  in  a  few 
instances  subsequently.  In  all  202  blood  examina- 
tions were  made  of  154  persons.  Of  79  patients 
who  showed  a  blue  line  on  the  gums,  also  satur- 
nine cachexia,  and  who,  in  addition,  were  com- 
plaining, no  degenerated  erythrocytes  were  found 
in  25 ;  in  13  of  these  25  not  even  after  repeated 
examination,  and  in  12  after  only  one  examina- 
tion. In  2,7  of  44  patients  without  blue  line  but 
with  cachexia  no  basophilia  was  found ;  in  19  of 
22  patients  with  a  suspicious  blue  line  and  mild 
cachexia  no  basophilia  was  detected ;  and  in  4  of 
9  patients  with  a  blue  line  and  without  cachexia 
there  were  no  degenerated  red  blood  corpuscles. 

In  546  lead  workers,  P.  Schmidt  found  basophilia 
absent  in  72*9  per  cent.;  in  17*9  per  cent,  there 
were  100  basophiles  per  million  red  corpuscles,  and 


THE  BLOOD  IN  SATURNINE  POISONING     129 

in  9/2  per  cent,  over  100  per  million.  Meyer  and 
Speroni  found  in  lead-poisoned  persons  basophilia 
present  one  day  and  absent  another.  Basophilia 
occurs  in  post-hgemorrhagic  anaemia,  especially  if 
the  bleeding  has  been  internal.  Otto  Nageli  * 
considered  that  in  these  cases  the  basophilia  stood 
in  direct  relation  to  the  absorbed  haemoglobin. 
During  the  administration  of  arsenic  to  a  child 
suffering  from  pseudo-leukaemia  the  number  of 
basophile  corpuscles  in  the  blood  rose  from  1,100 
to  17,160  per  cubic  millimetre  of  blood.  Nageli 
found  basophile  corpuscles  in  21  per  cent,  of 
healthy  persons,  and  that  their  number  increased 
after  a  meal  of  black  pudding.  Even  when  lead  is 
present  in  the  urine  basophilia  may  be  absent  in  the 
blood.  To  insist  that  a  case  is  not  one  of  plumbism 
unless  there  is  basophilia  is  to  assume  a  position 
which  experience  and  the  facts  recorded  above  do 
not  support. 

In  a  large  number  of  patients,  therefore,  in 
whom  one  would  expect  to  find  the  earliest  signs 
of  lead  poisoning  basophilia  is  absent.  It  is  hardly 
true,  therefore,  that  the  earlier  the  stage  of  the 
intoxication  the  more  sure  you  are  to  find  baso- 
philia. I  did  not  find  punctated  red  corpuscles  in 
the  blood  of  a  laboratory  rabbit  which  had  taken, 

*  "  Blutkrankheiten  und  Blutd,iagnostik."     Leipsic  :  Veit 
and  Co.,  1912,  p.  155,  etc. 

9 


130  LEAD  POISONING 

in  the  course  of  three  years,  1,095  grains  of 
nitrate  of  lead,  nor  was  it  present  in  fully  three- 
fourths  of  my  patients  who  were  the  subjects  of 
diachylon  poisoning,  and  in  whom  there  were 
blue  line  on  the  gums,  paralysis,  and  in  whose 
urine  lead  was  present.  The  patients  in  whom  I 
have  found  basophilia  were  less  frequently  in  the 
early  than  in  the  late  stages  of  the  malady.  Many 
physicians,  however,  find  basophilia  a  sign  of  great 
importance  in  the  diagnosis  of  lead  intoxication. 

One  point  concerning  basophilia  which  must  not 
be  lost  sight  of  is  that  the  technique  involved  in  the 
preparation  and  staining  of  the  blood,  also  the  care 
required  in  scrutinizing  the  field  under  high  magni- 
fying powers,  render  the  procedure  one  which  can 
hardly  be  undertaken  by  men  in  busy  medical  prac- 
tice. Under  these  circumstances  films  of  blood 
should  be  sent  to  one  of  the  Pathological  Research 
Societies,  of  which  there  are  now  several  in  the 
country. 

The  actual  nature  of  the  granules  seen  in 
basophile  red  corpuscles  is  not  quite  known. 
Some  writers  regard  them  as  signs  of  degenera- 
tion, other  authors  believe  them  to  be  regenera- 
tive.    I  have  tried  several  methods*  of  staining 

*  Dr.  Glibert,  Brussels,  uses  as  a  staining  agent  the 
following  :  Methylene  blue,  2  grammes  ;  soda  bicarbonate, 
12  grammes  ;  and  distilled  water,  200  grammes.  The  film 
of  dried  blood  is  steeped  in  absolute  alcohol  for  half  an 
hour  and  the  film  is  kept  in  the  staining  solution  one  minute. 


THE  BLOOD  IN  SATURNINE  POISONING     13; 

blood  for  basophilia.  Hamel  recommends  the 
following  :  Take  a  film  of  blood  from  the  cleansed 
lobe  of  the  ear  of  a  patient,  dry  the  film  in  the 
air ;  fix  the  blood  for  three  to  five  minutes  in 
absolute  alcohol ;  wash  in  water,  and  when  the 
slide  is  still  wet  pour  upon  it  a  few  drops  of 
Loeffler's  methyl  blue.  Shortly  afterwards  the 
slide  is  washed  in  water,  when  it  ought  to  show  a 
light  blue  stain.  If  it  is  too  light  it  can  be  stained 
again  with  Loeffler's  blue.  It  is  advisable  not  to 
stain  too  deeply,  otherwise  the  granules  cannot  be 
distinguished.  The  film  is  dried  between  blotting- 
paper,  and  warmed  for  a  moment  over  a  flame  in 
order  to  dry  it  completely.  The  effect  of  the  heat 
is  to  change  the  light  blue  into  a  light  green  stain. 
Under  an  oil-immersion  lens  the  nucleus  of  the 
white  corpuscles  is  seen  to  be  deep  blue,  while  the 
rest  of  the  contents  are  pale  and  colourless.  The 
erythrocytes  are  light  green,  and  in  those  which 
have  undergone  basophile  degeneration  dark  blue 
granules  may  be  recognized.  Polychromophil 
erythrocytes  must  not  be  mistaken  for  basophiles. 
In  them  the  staining  is  not  granular  but  general. 

In  health  the  red  blood  corpuscles  vary  in  size, 
but  in  plumbism  there  is  no  well-defined  altera- 
tion in  size  or  shape  of  corpuscle  peculiar  to  the 
malady,  or  which  can  be  regarded  as  pathogno- 
monic of  lead  poisoning. 

The  number  of  white  corpuscles  in  the  blood 


132  LEAD  POISONING 

varies.  In  some  patients  there  is  a  moderate 
leucocytosis,  in  others  there  is  a  leucopoenia. 
The  leucocytes  which  stand  out  most  prominently 
on  the  stained  field  are  sometimes  polymorpho- 
nuclears, in  other  instances  lymphocytes  are  more 
in  evidence.  As  to  why  there  should  be  in  one 
patient  polymorphonucleosis  and  in  another 
lymphocytosis  I  can  offer  no  opinion.  Occasionally 
eosinophile  corpuscles  are  present  in  slight  excess. 

Blue  Line  on  the  Gums. 

Next  to  anaemia  and  pallor  of  face,  one  of  the 
early  signs  of  plumbism  is  the  presence  of  a  blue 
line  in  the  mouth  close  to  the  margin  of  the  gums 
and  running  up  in  the  processes  between  the 
teeth.  The  depth  of  the  colour  varies.  It  is 
sometimes  bluish  -  black  or  a  light  slaty  -  blue. 
Although  usually  more  pronounced  in  persons  with 
decayed  teeth  and  unhealthy  gums,  also  in  those 
who  do  not  keep  their  teeth  clean,  I  have  seen  it 
in  persons  with  dentures  clean  and  well  pre- 
served. For  its  development  it  is  not  necessary 
to  have  a  preceding  gingivitis.  It  is  common 
experience  that  in  lead  workers  who  brush  their 
teeth  and  who  rinse  the  mouth  preparatory  to 
leaving  the  factory,  the  blue  line  may  be  absent. 
In  consequence  of  a  more  careful  personal  hygiene 
and  greater  attention  to  regulations,  a  blue  line  on 


BLUE  LINE  ON  THE  GUMS  133 

the  gums  is  less  frequently  observed  in  lead 
workers  than  was  the  case  a  few  years  ago. 
When  examined  with  a  lens  the  blue  line  exhibits 
a  punctated  appearance.  On  the  whole  the  line 
is  found  more  frequently  on  the  lower  than  the 
upper  gum,  and  it  is  absent  where  the  teeth  have 
been  removed.  On  one  occasion  the  presence  of 
a  well-marked  blue  line  on  the  red  matrix  of  an 
artificial  set  of  teeth  was  of  considerable  assistance 
to  me  in  making  a  diagnosis  of  lead  poisoning  in  a 
female  patient  of  Dr.  Walker,  Hebburn-on-Tyne. 
The  patient  was  the  subject  of  an  obscure  form  of 
nervous  disease,  accompanied  by  paralysis  of  the 
muscle  of  the  eyeball.  The  diagnosis  of  plumbism 
was  confirmed  by  detecting  lead  in  the  urine. 

In  lead  workers  engaged  in  a  dusty  process,  a 
blue  line  may  be  observed  on  the  teeth  or  on  the 
margin  of  the  gum  close  to  the  teeth.  This  is 
simply  a  deposit  of  sulphide  of  lead.  By  swilling 
the  mouth  with  warm  water,  and  by  friction  with 
a  toothbrush,  such  a  blue  line  will  almost  at  once 
disappear.  The  true  Burtonian  or  character 
istically  blue  line  of  plumbism  is  not  so  readily 
removed,  for  it  is  due  to  a  deposit  of  particles  of 
lead  sulphide  inside  the  cells  of  the  deeper  layers 
of  the  gum.  Probably  a  soluble  lead  salt  in  the 
mouth  has  been*  absorbed  by  the  cells,  and 
changed  into  sulphide  by  the  action  of  sulphuretted 
hydrogen  generated  by  decomposition  of  particles 


V 


134  LEAD  POISONING 

of  proteid  food  left  between  the  teeth,  by  the 
action  of  the  sulphur  in  the  sulphocyanide  of 
potassium  present  in  the  saliva,  or  the  blue  line 
is  the  result  of  phagocytic  cells  of  the  gum  taking 
up  and  retaining  particles  of  lead. 

Ruges  has  advanced  the  theory  that  the  blue 
line  is  due  to  lead  albuminate,  which  has  escaped 
from  the  capillaries  of  the  gum,  and  become  con- 
verted into  sulphide  by  the  action  of  sulphuretted 
hydrogen  in  the  mouth.  It  should  be  remembered 
that  lead  albuminate  is  not  very  soluble,  nor  does  it 
osmose  readily.  That  the  lead  which  is  deposited 
in  the  gums  can  be  carried  thither  by  the  blood 
from  the  tissues  is  confirmed  by  experience  such 
as  this — where  in  the  case  of  a  lead  worker  absent 
from  the  factory  for  a  few  months,  and  in  whom 
there  was  no  blue  line  on  the  gums,  there 
developed,  as  the  result  of  the  administration  of 
potassium  iodide,  not  only  double  wrist-drop,  but  a 
blue  line  on  the  gums  as  well. 

The  edge  of  the  gum  is  usually  abraded.  In 
older  workmen  the  gum  may  be  ulcerated.  In 
consequence  of  loss  of  substance  and  recession  of 
gum,  a  greater  length  of  the  fang  of  the  incisor 
teeth  is  shown  than  is  the  case  in  a  healthy 
mouth.  Just  inside  the  lower  lip,  or  on  the  inside 
of  the  cheek  opposite  a  decayed  tooth  there  may 
be    observed   a   bluish-black    patch,    irregular   in 


BLUE  LINE  ON  THE  GUMS  135 

outline,  and  varying  in  size  from  a  three-penny- 
piece  to  a  sixpence.     In  an  ordinary  way  where 
this  patch  is  present  it  is  usually  persistent.     That 
it  is  due  to  infection  by  friction  against  a  decayed 
tooth    is    confirmed    by    the    fact  of  the   patch 
disappearing   if  the   tooth    is    removed,    and    of 
another  patch  developing  on  the  inside  of  the  other 
cheek  opposite/a  tooth  which  has  become  coated 
with    tartar.  ^  A    blue    line    on    the    gums   with 
difficulty  distinguished  from  that  caused  by  lead, 
may  be  observed  in  persons  to  whom  large  doses 
of     bismuth     have    been    administered    by     the 
mouth,  or  who,  as  the  subjects  of  empyema,  have 
had   injected   into   the    fistulous   track    in    their 
thoracic  wall,  bismuth  emulsion.     A  blue  line  on 
the  gums,  with  a  greater  degree  of  shading  away 
from  the  margin  than  occurs  in  plumbism,  may  be 
met  with  in  persons  who  have  used  charcoal  as  a 
toothpowder.       The   particles   of  carbon   can  be 
extracted  by  a  fine  needle.     Close  to  the  teeth  on 
the  gum  of  a  coal-miner,  my  colleague,  Sir  George 
Hare  Philipson,  found  a  persistent  black  line  due 
to  particles  of  carbon.     On  the  gums   of  men  and 
women  who  are  engaged  in  making  up  a  blue  bed  in 
a  white  lead  factory,  a  brown  line  may  be  observed 
due   to   the   fine   dust    of    the   tan.      This    line, 
however,   has    no  permanence.     On  the  teeth  of 
men  working  in  copper,  a  greenish  line  may  be 


136  LEAD  POISONING 

observed.  In  cases  of  pyorrhoea  alveolaris,  the 
gums  may  exhibit  a  slight  blue  discoloration. 
Not  only  are  the  gums  and  the  inside  of  the  cheek 
discoloured  in  plumbism,  but  the  tongue  may 
become  bluish  as  well. 

The  presence  of  a  blue  line  on  the  gums  must 
not  be  taken  as  an  indication  that  its  owner  is 
suffering  from  lead  poisoning.  If  not  readily 
removable  by  a  toothbrush,  it  is  a  sign  that  lead 
is  in  the  system,  and  that  no  person  who  exhibits 
a  well-marked  blue  line  can  be  said  to  be  absolutely 
free  from  the  possibility  of  symptoms  of  plumbism 
developing.  Accompanied  by  other  symptoms  it 
is  a  valuable  sign. 

Colic  and  Constipation. 

Colic  and  constipation  are  early  symptoms  of 
lead  poisoning.  These  may  be  preceded  for  days 
or  weeks  by  an  unpleasant  metallic  taste  in  the 
mouth,  by  loss  of  appetite,  and  by  a  distaste  for 
food.  I  have  known  a  young  lead  worker  bring 
home  in  the  evening,  untouched,  the  meals  she 
had  taken  to  the  factory  in  the  morning.  A 
circumstance  such  as  this  is  a  clear  indication  that 
things  are  going  wrong.  It  was  so  in  this  par- 
ticular instance,  for  convulsions  unexpectedly 
developed,  which  proved  fatal  within  a  few  hours. 

Colic  may  be  so  severe  that  the  patient  cannot 


COLIC  AND  CONSTIPATION  137 

allow  of  any  pressure  being  made  upon  the 
abdomen.  In  other  instances  relief  is  obtained  by 
the  patient  placing  a  pillow  on  the  back  of  a 
chair,  and  pressing  the  abdomen  upon  it.  So 
severe  sometimes  is  the  pain,  that  the  patient  can 
hardly  be  kept  in  bed.  During  pain,  the  abdomen 
is  hard  and  retracted :  the  face  wears  an  anxious 
expression.  Vomiting  occasionally  accompanies 
the  pain.  The  pulse-rate  falls  :  it  is  small,  or  it 
may  feel  hard  and  feeble,  and  there  may  be  only 
twenty  to  thirty  beats  per  minute.  Riegel  found 
that  the  pulse  in  lead  colic  exhibited  high  tension. 
He  was  of  the  opinion  that  colic  might  be  due  to 
intestinal  spasm,  following  constriction  of  the 
arteries  in  the  splanchnic  area.  Such  high  blood 
pressure  is  not  an  invariable  accompaniment  of 
colic.  The  amount  of  urine  passed  during  the 
attack  of  colic  is  scanty  ;  frequently  it  is  not  more 
than  4  to  6  ounces  in  the  twenty-four  hours.  The 
cause  of  lead  colic  is  obscure.  Setting  aside  the 
arterial  constriction  just  mentioned,  also  irritation 
of  the  solar  plexus,  which  Harnack  claims  that 
lead  is  capable  of  causing,  I  have  found  in  animals 
who  have  died  from  acute  lead  poisoning  the  intes- 
tinal canal  irregularly  contracted  in  places  :  over 
a  length  of  2  to  3  inches  it  would  be  so  firmly 
contracted  as  to  have  its  calibre  completely 
obliterated,    so   that    while   the    pain    might    be 


.138  LEAD  POISONING 

explained  by  this  severe  muscular  spasm,  it  might 
also  be  the  result  of  the  upper  portion  of  the  intes- 
tine contracting  and  making  an  effort  to  propel  its 
contents  into  the  constricted  portion  below.  The 
pain  is  mostly  referred  to  the  neighbourhood  of 
the  umbilicus.  It  can  hardly  be  due,  as  Traube 
taught,  to  violent  intestinal  peristalsis  set  up  by 
an  accumulation  of  hardened  faeces,  for  pain  may 
be  present  when  there  is  no  constipation.  On  sub- 
sidence of  the  acute  pain  there  may  still  linger  for 
several  days  considerable  tenderness  revealed  by 
pressure  upon  one  side  or  other  of  the  abdomen,  the 
interesting  point  being  that  this  unilateral  tender- 
ness is  associated  with  inequality  of  the  pupils, 
inequality  of  the  radial  pulses,  also  with  greater 
pain  on  one  side  of  the  neck  than  the  other  on 
pressing  upon  the  course  of  the  vagal  nerves.  The 
inequality  of  the  pupil  suggests  irritation  of  certain 
strands  of  the  abdominal  sympathetic  system  of 
nerves.  There  may  be  also  unilateral  sweating  of 
a  portion  of  a  limb — e.g.,  one  hand. 

During  colic  sulphocyanide  of  potassium  is 
usually  absent  from  the  saliva.  On  the  addition  of  a 
weak  solution  of  liq.  ferri  perchlor.  to  the  saliva,  the 
reddish-brown  coloration,  characteristic  of  the  pre- 
sence of  sulphocyanide,  is  not  obtained,  but  it  will 
be  found  after  disappearance  of  the  abdominal  pain. 

In  women  who  have  taken  diachylon,  pain  may 


COLIC  AND  CONSTIPATION  139 

be  referred  to  the  pelvis ;  it  is  aggravated  on 
pressure,  and  on  vaginal  examination  the  uterus 
and  adnexa  are  found  to  be  tender  on  pressure. 

Sometimes  the  abdominal  pain  is  referred  to  the 
ileo-cascal  region.  Lead  colic  has  been  mistaken 
for  appendicitis,  and  patients  have  been  operated 
upon  for  supposed  appendicitis  when  the  case  was 
one  of  acute  plumbism.  One  of  my  hospital 
patients  was  primarily  admitted  into  the  surgical 
ward  to  be  operated  upon  for  what  appeared  to  be 
intestinal  obstruction.  There  were  absolute  con- 
stipation, severe  abdominal  pain,  faecal  vomiting, 
and  low  temperature  with  signs  of  collapse  ;  but  as 
there  were  also  retraction  of  the  abdomen,  a  blue 
line  on  the  gums,  and  albumin  in  the  urine,  the 
patient  was  not  submitted  to  operation.  He 
died  two  days  afterwards  from  uraemia  due  to 
plumbism  :  at  the  autopsy  the  kidneys  were 
found  to  be  atrophic,  and  there  were  no  evidences 
of  intestinal  obstruction.  There  is  no  reason  why 
a  lead  worker  should  not  suffer  from  appendicitis 
like  other  people,  but  the  history  of  the  occupation 
of  the  patient  and  a  careful  examination  of  the 
abdomen  as  to  the  seat  and  character  of  the  pain 
as  well  as  of  the  outline  of  the  abdomen  generally 
should  cause  us  to  hesitate,  and  not  with  undue 
haste  rush  into  an  operation.  It  is  rare  for  a 
patient  to  die  in  acute  lead  colic,  but  the  event 


I4Q  LEAD  POISONING 

is  possible.  Although  obstinate  constipation  is 
the  usual  accompaniment  of  lead  colic,  in  some 
instances  there  is  diarrhoea.  Removal  of  the  con- 
stipation in  plumbism  is  not  always  followed  by 
immediate  relief  to  pain. 

Types  of  Industrial  Plumbism. 

Owing  to  improved  methods  of  working, 
periodical  medical  examination  of  the  workers, 
and  greater  attention  to  regulations,  the  type  of 
plumbism  met  with  nowadays  is  usually  subacute 
or  chronic.  The  acute  type,  that  known  as 
saturnine  encephalopathy,  is  less  frequently  met 
with  than  twenty  years  ago.  Two  decades  ago  it 
was  a  frequent  mode  of  death,  particularly  in 
female  lead  workers.  It  was  the  high  mortality 
from  this  cause  that  induced  me  to  recommend  to 
the  Home  Office  the  abolition  of  female  labour  in 
the  dangerous  processes  of  white  lead  factories. 
Acute  plumbism  may  be  the  result  of  an  accident, 
as  in  the  case  recorded  of  a  labourer,  who  when 
carrying  a  barrel  of  red-lead,  allowed  the  barrel  to 
fall.  Almost  immediately  he  was  enveloped  in  a 
cloud  of  red  dust.  Some  of  this  was  inhaled  :  the 
dust  settled  in  his  nose  and  throat,  in  his  eyes  and 
ears,  also  in  his  hair,  and,  as  a  result,  symptoms  of 
acute  plumbism  developed. 


HEADACHE  14 1 

Headache. 

A  large  percentage  of  lead  workers,  when  ill, 
complain  of  headache.  It  is  characteristic  of  the 
headache  of  plumbism  that  the  pain  is  extremely 
severe.  It  respects  neither  sex  nor  age.  In  the 
absence  of  albumin  in  the  urine,  and  of  anatomical 
changes  in  the  retina,  but  with  a  history  of 
exposure  to  lead,  headache  is  of  diagnostic 
importance.  The  pain  is  not  confined  to  any 
particular  part  of  the  head  :  it  is  located  more 
frequently  in  the  vertical  and  occipital  regions. 
There  is  a  type  of  saturnine  headache  which  is 
rather  suggestive  of  neuralgia,  since  it  is  referred 
to  the  frontal  region,  and  is  associated  with 
arterial  spasm.  Sometimes  albumin  is  found  in 
the  urine  and  sometimes  not.  The  headache, 
although  of  toxic  origin,  is  not  always  ursemic. 
Severe  headache  may  be  followed  by  delirium. 
This  may  pass  off  in  the  course  of  a  few  days,  or 
it  may  persist  and  gravitate  into  acute  mania,  the 
aberrant  mental  condition  being  preceded  by  loss 
of  sleep.  A  maniacal  outburst  is  frequently  1/ 
attended  by  a  rise  of  temperature.  Instead  of 
delirium,  severe  headache  may  be  the  forerunner 
of  convulsive  seizures.  The  twitchings  commence 
in  one  half  of  the  face,  extend  to  the  arm  and  leg 
of  the   same    side,    after   which   the   convulsions 


142  LEAD  POISONING 

become  general.  The  fits  are  attended  by  loss  01 
consciousness.  The  development  of  convulsions 
in  a  lead  worker  is  of  serious  significance. 
The  muscular  movements  are  not  always  of 
ursemic  origin,  for  I  have  seen  them  occur  in  lead 
workers  in  whose  urine  there  was  no  trace  of 
albumin.  The  convulsive  attacks  constitute  what 
is  known  as  saturnine  encephalopathy.  In  some  of 
my  patients  the  attacks  have  been  preceded  by 
such  indications  of  nervous  folly  as  alternate 
laughing  and  crying,  symptoms  suggestive  of 
hysteria ;  but  this  form  of  toxic  hysteria  must  not 
throw  the  medical  attendant  off  his  guard,  for  too 
frequently  it  marks  a  deeper  and  more  severe 
affection  of  the  nervous  system  than  at  first  sight 
appears.  Within  two  to  three  days  after  an 
outburst  of  saturnine  hysteria  the  patient  may  be 
dead,  the  fatal  termination  having  been  preceded 
by  convulsions.  At  the  autopsy,  all  that  may  be . 
observed  are  a  dry  surface  of  the  brain,  flattened  i 
convolutions  and  constricted  bloodvessels ;  the 
whole  brain  looks  as  if  it  had  been  compressed,  and 
judging  from  its  pallor  it  would  appear  as  if  during 
life  there  had  been  considerable  pressure  consequent 
upon  widespread  spasm  of  the  cerebral  arteries. 

So  closely  do  the  brain  symptoms  in  plumbism 
resemble  those  of  cerebral  tumour — viz.,  severe 
headache,  vomiting,  one-sided  convulsions  with  or 


PLUMBISM  AND  LOSS  OF  VISION  143 

without  retinal  changes — that  the  cerebral  type  of 
plumbism  has  been  mistaken  for  tumour  of  the 
brain.  I  have  known  of  patients  trephined  for 
suspected  cerebral  tumour  when  the  case  was  one 
of  lead  poisoning,  in  whom  after  death  the  vascular 
changes  in  the  brain  were  those  purely  reactionary 
to  the  operation,  and  in  whose  brain  and  internal 
organs  lead  was  subsequently  found.  In  such 
cases  before  operating  assistance  might  be  ob- 
tained in  framing  a  diagnosis  by  an  examination 
of  the  urine  for  lead. 

Saturnine  encephalopathy  is  the  most  serious 
form  of  plumbism.  The  convulsions  keep  recur- 
ring. After  a  patient  has  lain  in  a  state  of 
coma  for  two  or  three  days,  consciousness  may 
return,  but  it  may  be  with  eyesight  lost.  On 
examining  the  eyes  by  the  ophthalmoscope, 
retinal  haemorrhages  or  acute  neuro-retinitis  may 
be  found.  Vision  may  be  permanently  lost,  or  it 
may  be  slowly  regained,  but  never  quite  completely. 
Saturnine  encephalopathy  is  fortunately  becoming 
much  more  rare  among  lead  workers. 

Plumbism  and  Loss  of  Vision. 

The  relationship  of  working  in  lead  and  loss  of 
vision  is  threefold.  There  is  a  loss  of  sight  in 
which  no  structural  changes  are  observed  in  the 
fundus  oculi ;    this   is  probably  of   toxic    origin,    J 


144  LEAD  POISONING 

and  due  to  a  functional  condition  of  the  nerve 
cells   in  the  deeper  visual    centres  of  the  brain, 
associated  possibly  with  spasm  of  the  bloodvessels 
leading  thereto,  for  the  amblyopia  is  transient  and 
rapidly  disappears.     Elschnig  *  found  in  a  patient 
who  was  suffering  from  lead  colic,  and  who  had 
suddenly  developed  amaurosis,  spasm  of  the  small/ 
arteries  of  the  conjunctivae  and  retinae.  The  spasm 
seemed  to  Elschnig  to  be  the  localized  result  of 
a  widely  distributed  action  of  lead,  not  only  upon 
the  musculature  of  the  bloodvessels  of  the  eye,  but 
also  upon  the  arteries  supplying  the  muscles  of  the 
eyeball.     There  occurred  paralysis  of  the  muscles 
of  accommodation  with  dilatation  of  the  pupil. 
In  the  other  forms  of  blindness  there  are  structural 
alterations  in  the  disc  and  retina.     When  blind- 
ness follows  headache  and  convulsions  the  discs  are 
hyperaemic,  swollen,  and  mottled,  the  borders  are 
ill-defined  and  irregular,  the  bloodvessels  in  places 
are  obscured,  delicate  white  striae  lie  external  to 
them  in  their  course,  the  veinules  are  distended, 
and  haemorrhages  may  be  observed  in  the  retinae. 
These  ophthalmoscopic  changes  are  characteristic 
of  saturnine  encephalopathy,  and    they  may    be 
found  in  young  lead  workers  who  have  been  in  a 
factory  only  a  few  months.     Should  the  patient 
recover  from  the  convulsive  seizures  vision  is  never 
*  Wien.  Med.  Wochenschr.,  1898. 


PLUMBISM  AND  LOSS  OF  VISION  145 

quite  regained,  for  the  haemorrhages  may  never  be 
entirely  absorbed,  and  the  discs  may  atrophy. 
Such  intra-ocular  changes  as  those  just  described 
may  occur  in  lead  workers  whose  urine  is  free  from 
albumin,  but  in  the  third  form  of  blindness  the 
patient  may  be  the  subject  of  kidney  disease.  It 
is  the  second  form  which  is  characteristic  of 
saturnine  encephalopathy.  How  the  intra-ocular 
changes  are  brought  about  it  is  difficult  to  say. 
It  is  maintained  by  some  physicians  that  lead  acts 
mechanically  :  by  inducing  effusion  into  the  sub- 
arachnoid spaces  of  the  brain  it  is  believed  to 
cause  distension  of  the  sheath  of  the  optic  nerve. 
Amenorrhoea  is  considered  to  be  a  predisposing 
cause,  but  as  the  eye-changes  occur  in  males  as 
well  as  in  females,  and  of  the  latter  especially  in 
those  who  have  been  the  subjects  of  menorrhagia, 
clearly  this  cannot  be  the  cause.  In  one  of  my 
patients  who  died  in  the  acute  attack  not  only  was 
the  surface  of  the  brain  flattened  as  if  compressed, 
but  there  was  also  a  small  quantity  of  serous  fluid 
in  the  ventricles.  On  section  of  the  optic  nerve, 
while  the  central  bloodvessel  appeared  to  be 
healthy,  there  was  found  on  microscopical  exami- 
nation round-celled  infiltration  of  the  fibrous 
trabecular  between  the  bundles  of  nerve  fibres,  the 
infiltration  being  most  marked  at  the  posterior 
portion,  and  for  some  distance  behind  the  lamina 

10 


146  LEAD  POISONING 

cribrosa.  The  disc  was  swollen.  In  the  body  of 
a  lead  worker  who  has  died  from  saturnine 
encephalopathy  the  brain  signs  may  be  negative  ; 
in  another,  in  addition  to  pallor,  there  may  be 
fewer  puncta  hsemorrhagica  than  usual,  and  only  a 
dram  or  so  of  fluid  in  the  lateral  ventricles.  Dr. 
Mosny,  of  the  Hopital  St.  Antoine,  Paris,  found  in 
the  brain  of  persons  dying  from  acute  plumbism 
with  nervous  phenomena  small  haemorrhages  in  the 
cortex  of  the  brain.  Similar  minute  haemorrhages 
have  been  found  in  the  brain  of  animals  the 
subjects  of  experimental  lead  poisoning.  Dr.  F. 
W.  Mott  found  on  microscopical  examination 
miliary  haemorrhages  in  the  perivascular  sheaths 
of  the  small  vessels  of  the  cortex  and  of  the  sub- 
stance of  the  brain  in  a  coach  painter  who  had  had 
epileptic  seizures.  Goadby,*  in  his  experiments 
upon  animals  which  had  inhaled  lead  dust,  found 
minute  haemorrhages  at  the  base  of  the  brain  and 
over  the  vertex.  "  Minute  haemorrhages  were 
found  often  underneath  the  arachnoid  membrane, 
but  the  largest  haemorrhages  were  always  found  at 
the  base  of  the  brain  and  spreading  down  into  the 
spinal  canal  along  the  medulla." 

*  "  Lead  Poisoning  and  Lead  Absorption,"  p.  192.    Legge 
and  Goadby. 


NERVOUS  SYSTEM  147 

Nervous  System. 

The  cells  of  the  central  nervous  system  and  the 
fibres  of  the  peripheral  nerves  are  prone  to  be 
affected  by  lead,  and  this  not  only  by  lead  com- 
pounds directly  introduced  into  the  body,  but 
also  by  the  liberation  and  re-solution  of  organic 
lead  combinations  which  had  been  stored  up  in 
the  system,  and  were  not  causing  symptoms.  Such 
occurrences  take  place  in  persons  who  are  the 
subjects  of  chronic  plumbism ;  also  in  women 
who  have  taken  diachylon  there  are  these 
ingravescent  periods.  It  would  seem  as  if  now 
and  again  there  passed  over  the  system  waves  of 
poisoning  owing  to  reabsorption  of  minute  quan- 
tities of  lead  which  had  been  deposited  in  the 
intestinal  canal  or  elsewhere.  Some  lead  workers 
complain  of  a  gradual  weakening  of  the  muscular 
power,  especially  of  the  hands  and  wrists.  A 
cooper  in  a  lead  factory,  for  example,  may  find  as 
one  of  the  earliest  symptoms  that  he  cannot  grip 
or  use  the  hammer  as  well  as  formerly.  Such 
paresis  may  gravitate  into  paralysis.  In  a  large 
number  of  patients  loss  of  power  in  both  hands 
develops  without  there  having  been  colic.  Between 
night  and  morning  a  lead  worker,  after  or  without 
premonitory  symptoms,  may  develop  double 
wrist-drop.     Only   occasionally   is   the    paralysis 


148  LEAD  POISONING 

preceded  by  pain  in  the  muscles  and  nerves. 
The  fact  that  both  hands  are  usually  affected 
suggests  that  a  general  cause  such  as  a  poison  has 
been  in  operation,  but  the  wrist-drop  may  be 
present  on  one  side  only,  or  if  it  is  double  it  is 
observed  to  be  more  pronounced  on  one  side  than 
the  other.  Dr.  Ludwig  Teleky  is  of  the  opinion 
that  the  paralysis  of  lead  poisoning  affects  with 
greater  severity  the  muscles  which  are  most  used 
by  a  person  in  his  occupation.  He  considers 
fatigue  to  be  a  contributory  cause.  The  fact  of 
certain  muscles  being  more  profoundly  involved 
in  lead  poisoning  compared  with  others  would 
thus  be  partly  explained  by  the  occupation  the 
individual  had  followed.  The  theory  which 
held  that  the  muscles  affected  are  those  immedi- 
ately under  the  skin,  through  which  at  particular 
parts  of  the  body  absorption  of  lead  might  have 
taken  place,  has  few  adherents.  In  the  case  of 
file-cutters  the  muscles  of  the  fingers  of  the  left 
hand,  since  they  grip  the  chisel,  suffer  more  than 
those  of  the  right  hand,  which  raises  the  hammer. 
During  the  striking  of  the  chisel,  the  left  hand  rests 
more  upon  the  lead  cushion,  but  notwithstanding 
this  there  is  greater  and  more  continuous  strain  of 
the  fingers  of  the  left  than  of  the  right  hand.  In  the 
case  of  house  and  coach  painters,  owing  to  the 
manner  in  which  the  brush  is  held,  the  right  index 


NERVOUS  SYSTEM  149 

finger  and  thumb  suffer  most.  In  a  street  lamp- 
lighter suffering  from  plumbism  I  found  only  the 
muscles  of  the  right  hand  affected — viz.,  those 
concerned  in  pronation  and  supination.  Goadby, 
adopting  the  teaching  of  Edinger  and  Teleky, 
maintains  that  the  paralysis  of  lead  poisoning  is  in 
some  way  associated  with  previous  muscular  strain, 
and  that  it  is  influenced  by  the  relative  weights  and 
volumes  of  the  muscles  of  the  hands  and  forearms. 
He  considers  that  previous  exertion  plays  a  part  in 
locating  the  paralysis.  Goadby  found  in  experi- 
mental plumbism,  as  the  result  of  rupture  of  small 
bloodvessels,  minute  haemorrhages  in  groups  of 
muscles  which  were  functionally  related.  Since 
certain  groups  of  muscles  are  made  use  of  in 
some  trades  more  than  others,  it  is  maintained 
that  as  greater  stress  is  thrown  upon  these  muscles 
during  work,  not  only  does  this  circumstance  deter- 
mine the  haemorrhages  but  it  explains  also  the 
paralysis.  On  microscopical  examination  minute 
<4  extravasations  of  blood  may  also  be  seen  in  the 
nerves  which  supply  the  paralyzed  muscles. 

Weakness  of  the  wrists,  with  or  without  tremor, 
is  an  early  sign  of  plumbism  ;  it  is  frequently 
a  forerunner  of  paralysis.  The  extensor  muscles 
of  the  wrists,  the  interossei,  the  common  extensor 
of  the  fingers,  and  the  extensor  of  the  forefinger 
are  among  the  first  muscles  to  become  paralyzed. 


150  LEAD  POISONING 

When  the  loss  of  power  is  complete,  patient  is 
unable  to  extend  the  wrist.  Any  attempt  to  do  so 
or  to  straighten  the  fingers  is  followed  by  a 
quivering  and  a  drawing  inwards  of  the  semi-flexed 
and  helpless  fingers  towards  the  palm  of  the  hand. 
Notwithstanding  this  loss  of  power,  the  hand  can 
still  be  pronated  and  supinated.  The  muscles 
which  are  paralyzed  are  innervated  by  the  musculo- 
spiral  The  supinator  longus  muscle,  although 
supplied  by  the  same  nerve,  is  not  paralyzed,  partly 
owing  to  its  size,  and  the  fact  that  it  belongs  to 
the  flexor  group,  and  is  innervated  from  another 
source  in  addition  to  the  musculo-spiral. 

Three  or  four  different  types  of  lead  paralysis 
are  met  with.  They  are  more  or  less  classical, 
but  patients  often  seek  advice  for  loss  of  muscular 
power  when  the  paralysis  does  not  conform  to 
any  definite  type.  In  a  general  way  it  ma}7  be 
said  that  in  the  largest  number  of  instances  the 
paralysis  affects  the  extensors  of  the  fingers, 
thumbs,  and  wrists.  The  extensor  and  abductor 
muscles  are  always  more  readily  affected  than  the 
flexors  and  adductors.  Considering  their  volume, 
the  muscles  of  the  fingers  have  much  work  to  do. 
Paralysis  of  the  muscles  just  mentioned  takes 
place  independently  both  of  the  channel  by  which 
lead  gains  an  entrance  into  the  body  and  of  the 
kind    of    occupation    the    patient    has    followed. 


NERVOUS  SYSTEM  151 

Remak  described  a  form  of  paralysis — the  brachial 
type — in  which  the  muscles  affected  are  the  deltoid, 
biceps,  brachialis  anticus,  and  supinator  longus, 
the  so-called  Duchenne-Erb  group,  with  frequently 
the  supra-  and  infra-scapular  muscles  as  well.  In 
this  type  the  deltoid  is  the  muscle  first  affected, 
and  it  alone  may  be  involved ;  in  other  instances 
the  supinator  longus  may  alone  be  paralyzed. 
When  the  deltoid  is  affected,  the  arm  hangs 
loosely  by  the  side  of  the  body — it  cannot  be 
raised ;  the  humerus  is  rotated  inwards,  and  the 
arm  is  semi-prone.  In  the  commonest  form  of 
lead  paralysis,  where  the  extensors  of  the  wrist 
and  fingers  are  involved,  the  antibrachial,  or 
Dejerine-Klumpke  type,  the  supinator  longus  is 
not  affected  ;  in  the  first  form  supination  is  im- 
possible owing  to  implication  of  the  supinator 
brevis.  In  the  second  type  the  extensors  of  the 
index  and  little  fingers  become  paralyzed  :  so,  too, 
the  long  extensor  of  the  thumb.  The  hand  droops 
in  a  semi-prone  position,  hence  the  term  "wrist 
drop  "  applied  to  it.  There  is  another  form  of 
paralysis,  the  Aran-Duchenne  type,  mostly  con- 
fined to  the  small  muscles,  the  outer  borders  of  the 
hand,  and  those  of  the  thumb  and  interossei.  The 
hypothenar  and  the  thenar  eminences  lose  their  ful- 
ness, and  the  interosseal  grooves  deepen.  Atrophy, 
which  is  generally  pronounced,  accompanies  the 


152  LEAD  POISONING 

paralysis.  There  is  usually  also  fibrillary  tremor, 
so  that  the  hand  resembles  that  observed  in  pro- 
gressive muscular  atrophy.  While  lead  paralysis 
affects  with  greater  frequency  the  muscles  of  the 
upper  extremity — a  circumstance  which  roughly 
distinguishes  it  from  loss  of  power  due  to  arsenic 
and  alcohol — yet  the  muscles  of  the  leg  may 
become  involved,  giving  rise  to  the  peroneal 
type  of  lead  paralysis,  in  which  the  peronei 
muscles  and  extensors  of  the  toes  are  affected,  the 
tibialis  anticus,  like  the  supinator  longus  in  the 
forearm,  escaping.  The  peroneal  type  of  lead 
palsy  is  usually  preceded  by  such  prodromata  as 
pains  in  the  legs,  with  a  sense  of  numbness  and 
tingling,  or  there  is  hyperesthesia.  Tancquerel 
states  that  this  type  of  paralysis  forms  13  per 
cent,  of  all  the  cases.  This  percentage  is  over- 
stated so  far  as  Great  Britain  is  concerned.  The 
peroneal  type  of  lead  paralysis  may  occur  alone, 
it  may  accompany  the  loss  of  power  of  hands  and 
wrists,  or  be  part  of  a  wider  distribution  of  loss  of 
power,  in  which  the  psoas  and  other  muscles  con- 
nected with  the  pelvis  are  involved.  In  young 
children  lead  paralysis  affects  particularly  the 
lower  extremities,  probably  because  children  run 
about  more  than  adults,  and,  on  Edinger's  theory, 
their  muscles  would  be  more  exposed  to  fatigue, 
and  therefore  more  likely  to  be  influenced  by  lead. 
In  addition  to  paralysis  of  hands,  forearms,  and 


NERVOUS  SYSTEM  153 

legs,  the  loss  of  power  may  be  widely  distributed, 
so  as  to  involve  more  completely,  not  only  the 
bulk  of  the  muscles  of  the  limbs,  but  those  of  the 
back  as  well.  Such  a  general  and  widespread 
distribution  of  paralysis  occurred  in  one  of  my 
patients  within  twenty-four  hours.  The  woman 
lay  in  bed  like  a  log,  unable  to  move  or  to  help 
herself.  The  intercostal  muscles  became  affected, 
so  that  respiration  was  carried  on  with  difficulty. 
Usually  in  this  form  of  paralysis  the  muscles  of 
the  head  and  neck  are  respected.  This  widely 
distributed  paralysis  is  admitted  to  be  extremely 
serious,  yet  in  the  two  instances  in  which  I  have 
seen  it  both  patients  recovered.  Four  years  after- 
wards one  of  them  gave  birth  to  a  living  child. 
Although  in  these  cases  it  is  exceptional  for  death 
to  take  place  from  asphyxia,  as  sometimes  occurs 
in  acute  ascending  paralysis,  yet  Strauss  and 
Heugas*  have  published  the  details  of  a  case  in 
which  death  was  due  to  respiratory  paralysis. 
The  muscles  of  the  larynx  occasionally  become 
affected ;  so,  too,  those  of  the  bladder.  In  some 
of  the  less  usual  forms  of  plumbism  the  muscles 
of  the  eyeballs  are  paralyzed.  There  may  be 
ptosis  or  diplopia  ;  the  pupils  may  be  unequal. 
In  a  young  married  woman,  aged  twenty,  who 
had  taken  diachylon  to  induce  abortion,  I  found 

*  Heugas,    "  Contributions    a    l'Etude    de    la    Paralysie 
Saturnine,"  p.  54. 


154  LEAD  POISONING 

paralysis  of  the  external  rectus  muscle  of  each 
eyeball,  more  pronounced  in  the  right  than  the 
left.  There  was  double  neuro-retinitis,  running 
on  to  atrophy  of  the  disc.  Here  and  there  in  the 
fundus  were  minute  haemorrhages.  During  the  time 
patient  was  under  hospital  observation  she  was 
almost  completely  blind.  She  had  taken  only  a 
small  fraction  of  a  pennyworth  of  lead  oleate. 
She  never  had  colic,  only  severe  headache  ;  no 
vomiting.  Lead  was  never  found  in  her  urine. 
There  was  a  deep  blue  line  on  the  gums. 

Sensory  Symptoms. 

Pain  may  precede  the  various  forms  of  paralysis 
met  with  in  lead  poisoning,  but  once  muscular 
power  is  lost  pain  is  not  a  prominent  symptom 
unless  in  patients  whose  legs  are  paralyzed.  In 
wrist-drop  there  can  occasionally  be  detected 
patches  of  analgesia  and  anaesthesia  on  the  inner 
and  posterior  aspects  of  the  forearm.  On  the  leg 
similar  patches  may  be  found  when  the  lower 
extremities  are  involved.  In  females,  the  loss  of 
sensation  may  be  such  as  to  suggest  a  hysterical 
or  functional  origin  of  the  anaesthesia ;  but  if  the 
skin  is  pricked  blood  fairly  readily  flows,  showing 
that  there  is  none  of  the  ischaemia  which  is  a 
feature  of  the  hysterical  state. 

Tremor  is  an  important  sign  of  plumbism.  It 
affects  mostly  the  hands,  head,  and  neck.     A  local- 


SENSORY  SYMPTOMS  155 

ized  tremor  can  be  brought  into  evidence  in  lead 
workers  who  are  not  ill,  in  whom  there  is  nothing 
but  pallor,  with  or  without  a  blue  line  on  the  gums, 
by  asking  them  to  show  their  teeth.  The  action  is 
accompanied  by  well-marked  tremor  of  the  naso- 
labial fold  of  muscles.  In  patients  the  subjects  of 
chronic  plumbism,  and  whose  speech  is  slow  and 
syllabic,  there  is  sometimes  tremor  of  the  tongue 
when  it  is  protruded.  The  tremors  are,  if  any- 
thing, coarser  than  those  observed  in  persons 
suffering  from  general  paralysis.  Where  there  is 
wrist-drop  the  tremor  may  only  affect  the  fingers. 
In  one  man,  when  the  hands  were  outstretched, 
tremor  always  commenced  in  the  left  thumb,  and 
gradually  extending  up  the  arm,  the  whole  limb 
became  so  violently  agitated  that  the  movements 
passed  beyond  the  control  of  the  patient. 

Of  the  mental  symptoms  which  are  occasionally 
observed  in  lead  poisoning,  mention  may  be  made 
of  acute  delirium.  This  may  develop  indepen- 
dently of  convulsions  or  coma,  and  it  may  be 
unattended  by  a  rise  of  temperature.  In  one 
female  patient  the  delirium  was  accompanied  by 
fever,  but  she  was  the  subject  of  acute  mania  and 
had  to  be  removed  to  an  asylum.  Lead  poisoning 
is  a  cause  of  delusions.  Years  after  the  attack  the 
patient  informed  me  that  when  the  severe  pain  in 
her  head  subsided,  she  was  under  the  impression 
that  she  had  received  a  message  to  go  to  America. 


156  LEAD  POISONING 

About  midnight  one  evening  she  was  found  by  the 
police  patrolling  the  deck  of  a  steamer  lying  in  the 
Tyne.  After  a  few  months'  residence  in  an  asylum 
she  recovered,  was  discharged,  and  there  has  been 
no  recurrence  of  her  mental  symptoms. 

Saturnine  Pseudo-General  Paralysis  : 
Wassermann  Reaction. 

In  some  of  my  male  patients  the  symptoms  have 
resembled  those  met  with  in  general  paralysis. 
There  are  slow  and  interrupted  speech,  fibril- 
lary tremor  of  tongue,  also  of  naso-labial  muscles, 
defective  memory,  inequality  of  pupils,  slight 
staggering  in  walking,  and  exaggerated  or  absent 
knee-jerk,  but  there  are  none  of  the  exalted  ideas 
nor  of  the  irascibility  of  temper  which  are  promi- 
nent symptoms  of  the  classic  type  of  general 
paralysis.  Besides,  whilst  recovery  may  take 
place  in  the  saturnine  form  of  the  malady  it  is  not 
known  to  occur  in  the  other.  A  lead  worker  who 
has  incurred  the  risk  of  catching  syphilis  is 
equally  liable  to  general  paralysis  like  other  men. 
In  the  brain  of  one  of  my  lead  patients  who  had 
presented  symptoms  of  general  paralysis  there 
was  found  at  the  autopsy  meningitis  with  sub- 
arachnoid effusion  in  the  neighbourhood  of  the 
fissure  of  Rolando.  Although  no  history  of 
syphilis  was  obtainable,  the  character  of  the  brain 


SATURNINE  PSEUDO-GENERAL  PARALYSIS     157 

lesion  rather  suggested  that  such  a  disease  had 
existed.  I  have  tried  the  Wassermann  reaction  in 
many  patients  suffering  from  plumbism.  I  have 
found  it  positive  both  in  male  and  female  patients. 
The  resemblance  of  saturnine  pseudo-general 
paralysis  to  the  ordinary  and  better-known  type 
calls  for  comment  owing  to  the  fact  that  in  both 
diseases  there  is  the  same  tendency  for  the 
bloodvessels  to  become  affected  at  a  compara- 
tively early  age,  for  the  membranes  of  the  brain 
to  become  occasionally  involved,  and  also  on 
account  of  the  response  to  the  Wassermann  test. 
At  a  meeting  of  the  Societe  Medicale  des  Hopi- 
taux,  Paris,  February  20,  1914,  Messrs.  Oettinger, 
Pierre-Louis,  Marie,  and  Baron  raised  the  ques- 
tion of  the  association  of  Wassermann's  reaction 
and  plumbism.  The  patient,  who  was  a  red  lead 
furnace-man,  aged  thirty-three,  and  who  denied 
syphilis,  had  suffered  from  colic  and  from  pains  in 
the  arms  and  shoulders  ;  there  were,  in  addition, 
muscular  atrophy  and  mild  basophilia.  Both  the 
blood  and  the  fluid  removed  from  the  spinal  cord 
by  lumbar  puncture  gave  a  positive  Wassermann 
reaction  ;  the  spinal  fluid  showed  hyperalbumin- 
osis  and  leucocytosis.  Eleven  days  after  having 
been  treated  by  sulphur  baths  and  sulphur 
administered  internally  there  was,  on  examining 
the   spinal   fluid,    no   longer   any   lymphocytosis. 


158  LEAD  POISONING 

The  amount  of  albumin  in  the  spinal  fluid  had 
diminished,  while  both  of  it  and  the  blood  a 
Wassermann  test  was  negative.  Patient  made  a 
good  recovery.  The  fact  of  a  positive  Wasser- 
mann reaction  having  been  obtained  on  the  first 
occasion  raises  the  question  as  to  whether  there 
was  latent  syphilis  to  explain  the  character  of  the 
meningeal  fluid,  but  the  fleeting  nature  of  the 
reaction  and  the  early  return  of  the  spinal  fluid  to 
its  normal  were  regarded  as  rendering  untenable 
this  supposition.  Dreyer,*  out  of  thirty-five  cases  of 
plumbism  obtained  positive  Wassermann  reaction 
in  four.  Schnitterf  obtained  positive  Wassermann 
reaction  in  four  out  of  fourteen  men  who  had 
worked  in  lead  and  who  were  the  subjects  ot 
chronic  plumbism.  As  in  none  of  these  men 
syphilis  could  be  confirmed  he  insists  upon  the 
non-syphilitic  character  of  the  reaction  in  satur- 
nine intoxication.  Cyrus  Field  |  obtained  positive 
Wassermann  reaction  in  the  blood  of  five  out  ot 
twelve  lead-poisoned  patients.  Oettinger,  Marie, 
and  Baron  induced  lead  poisoning  in  six  guinea- 

*  "  Ueber  die  W.-  R.  bei  Bleivergifteten,"  Deutsch.  Med. 
Woch.,  191 1,  No.  17,  p.  786. 

f  "  W.  R.  bei  Bleivergifteten,"  Deutsch.  Med.  Woch., 
191 1,  No.  22,  p.  1030. 

J  "  The  Occurrence  of  a  Positive  Wassermann  Reaction 
in  a  Case  of  Lead  Poisoning,"  Jour  11.  Ainer.  Med.  Assoc, 
1913,  No.  22,  p.  1681. 


SATURNINE  PSEUDO-GENERAL  PARALYSIS     159 

pigs  by  means  of  acetate  of  lead  introduced  into 
the  body  by  various  channels  without  obtaining 
in  one  single  instance  a  positive  reaction,  no 
matter  the  stage  of  the  intoxication  and  the 
presence  of  basophilia.  Schnitter  holds  that  the 
Wassermann  reaction  bears  a  relation  to  the 
number  of  basophile  corpuscles  present  in  the 
blood,  but  in  this  opinion  he  is  not  supported  by 
other  physicians,  nor  did  the  experiments  on 
guinea-pigs  just  referred  to  support  the  state- 
ment. According  to  Oettinger,  Marie,  and  Baron 
a  positive  Wassermann  reaction  obtained  in  the 
course  of  saturnine  intoxication  does  not  allow  us 
to  conclude  that  it  points  to  a  syphilitic  origin. 
Sicard  and  Bloch*  having  obtained  a  positive 
Wassermann  reaction  in  the  cerebro-spinal  fluid 
of  three  men  the  subjects  of  general  paralysis,  in 
all  of  whom  a  saturnine  association  was  more  than 
probable,  are  of  the  opinion  that  saturnism  can 
only  be  a  coincidence  in  the  development  of 
general  paralysis.  They  maintain  that  they  have 
never  obtained  a  positive  reaction  in  persons 
suffering  from  acute  or  chronic  plumbism  in 
whom  there  was  no  history  of  syphilis  or  the 
possibility  of  it.  In  my  infirmary  lead  patients  I 
only  obtained    a   positive    reaction  where    I  had 

*  "  Saturnisme   et    Paralysie    Generale,"   Revue   Neurol., 
2e  semaine,  p.  118.     1910. 


i6o  LEAD  POISONING 

reason  to  believe  that  in  addition  to  plumb- 
ism  there  was  a  specific  taint.  Its  absence  in  a 
male  patient  whom  I  had  regarded  as  a  pseudo- 
general  paralytic,  with  the  sequel  of  plumbism, 
supported  the  attitude  I  had  taken  up  in  the 
matter.  With  the  view  of  ascertaining  in  what 
percentage  of  lead  workers  a  positive  Wassermann 
reaction  might  be  obtained  in  men  still  follow- 
ing their  occupation,  I  asked  permission  of  Dr. 
Irvine  to  allow  me  to  make  tests  upon  some  of  the 
workers  in  the  factory  of  which  he  is  the  medical 
adviser.  With  the  assistance  of  Dr.  H.  J.  Slade, 
Bacteriologist  to  the  Royal  Victoria  Infirmary, 
Newcastle,  we  took  the  blood  of  different  sets  of 
work-people  in  different  weeks.  The  following 
are  the  results  :  (a)  Of  blood  of  n  men  examined 
8  gave  a  positive  reaction  ;  (b)  of  blood  of  n  men 
examined  4  gave  a  positive  reaction.  Whatever 
view  we  take  of  the  Wassermann  reaction  the  fact 
remains  that  plumbism  gives  rise  to  a  series  of 
nervous  phenomena  closely  resembling  those  ob- 
served in  general  paralysis.  The  two  conditions, 
however,  are  quite  distinct.  It  is  not  always 
the  case  of  syphilitic  general  paralysis  having 
developed  in  a  person  who  is  at  the  same  time  the 
subject  of  plumbism,  but  of  a  malady  inexplicably 
the  outcome  of  saturnism  exerting  its  final  influence 
upon  the  central  nervous  system. 


GENERAL  PATHOLOGICAL  REVIEW        161 

General  Pathological  Review  of  the 
Subject. 

The  symptoms  of  lead  poisoning,  whether  caused  t/ 
by  working  in  lead,  inhaling  dust,  or  drinking 
water  contaminated  by  lead,  are  due  to  (i)  lead 
compounds  circulating  in  the  blood  ;  (2)  the  for- 
mation and  retention  of  toxic  products  within  the 
system  causing  deranged  function  of  the  excretory 
organs  ;  and  (3)  to  structural  changes  of  internal 
organs  consequent  upon  the  action  of  lead  or  of  the 
toxic  bodies  produced  as  consequences  of  it.  All 
physicians  are  agreed  that  plumbism  is  more  likely 
to  be  the  result  of  the  frequently  repeated  entrance 
of  small  quantities  of  lead  into  the  system  than  of 
one  or  two  large  doses.  Where  large  doses  of 
lead  are  given  by  the  mouth — e.g.,  15  or  20  grains 
of  acetate  of  lead — only  a  minute  quantity  of  this 
is  likely  to  be  absorbed.  The  bulk  of  it  is  thrown 
out  in  the  fasces,  but  in  the  case  of  a  lead  worker 
who  is  breathing  or  swallowing  dust,  minute 
quantities  only  reach  the  internal  economy  at  a 
time.  As  in  the  latter  instance  exposure  to  the 
metal  continues  for  months  or  years,  considerable 
quantities  of  lead  can  thus  be  absorbed  over  the 
extended  period.  Ordinarily  the  elimination  of 
lead  keeps  pace  with  absorption,  and  so  long  as 
the  workman  is  having  good  meals,  digesting  his 


1 62  LEAD  POISONING 

food  well,  and  is  giving  attention  to  details  of 
personal  hygiene,  health,  in  spite  of  the  harmful 
nature  of  the  work  in  a  lead  factory,  may  be  well 
maintained ;  but  if  there  is  any  idiosyncrasy  or 
personal  susceptibility  to  the  metal,  if  there  are 
poverty  and  semi-starvation,  excessive  indulgence 
in  alcohol,  or  the  supervention  of  illness,  elimina- 
tion of  lead  by  the  faeces  becomes  checked,  and 
health  may  become  undermined.  It  is  therefore 
the  frequently  repeated  minor  injuries  inflicted 
upon  the  cells  of  the  body  and  upon  the  internal 
organs  by  lead  which  do  harm.  Lead  may  be 
stored  up  in  the  body  for  years,  as  in  the  case  of  a 
bullet  which  becomes  encysted,  or  it  may  have 
been  deposited  as  a  comparatively  insoluble 
albuminate,  and  given  rise  to  no  trouble  until 
Vmetabolism  becomes  deranged,  when  the  inert 
lead  becomes  dissolved  and  is  reabsorbed  into  the 
blood.  So  far  as  workers  in  lead  are  concerned  it 
is  difficult  to  say  what  length  of  time  is  required 
of  persons  exposed  to  lead  for  symptoms  of 
plumbism  to  develop.  Employers  in  the  United 
States  are  of  the  opinion  that  the  best  way  to 
protect  workmen  is  to  keep  them  in  the  factory  only 
for  a  short  period — a  few  weeks  or  a  few  months 
at  most — employed  in  dangerous  processes. 
British  experience,  on  the  other  hand,  shows  that 
it  is  the  casual  workers  in  the  lead  factories  who 


GENERAL  PATHOLOGICAL  REVIEW        163 

suffer  most.  Where  men  follow  the  employment 
regularly  owners  of  works  are  more  likely  to  intro- 
duce improvements  than  when  the  labour  is  largely 
casual.  In  visiting  a  large  lead  works  on  the 
Continent  some  months  ago,  although  several  of 
the  men  looked  pale  and  somewhat  ill,  I  was 
struck  by  the  register  showing  a  remarkable 
freedom  on  the  part  of  the  men  from  sickness. 
On  drawing  the  manager's  attention  to  the  cir- 
cumstance, he  attributed  the  freedom  from  illness 
on  the  part  of  the  men  to  the  fact  that  the  firm  did 
not  allow  the  men  to  stay  long  enough  for  them  to 
become  ill.  The  workmen  were  kept  circulating. 
In  Great  Britain  the  workmen  stay  longer  with 
white  lead  manufacturers  than  they  do  in  many 
parts  of  the  Continent  and  the  United  States. 

Since  in  lead  workers  plumbism  is  the  result  of 
the  inhalation  or  swallowing  of  plumbiferous  dust, 
the  date  at  which  symptoms  of  poisoning  develop 
will  be  influenced  by  the  amount  of  dust  in  the 
atmosphere,  by  ventilation,  previous  state  of 
health  of  the  work-people,  and  their  susceptibility. 
Tancquerel  mentions  the  case  of  a  man  who 
developed  paralysis  after  having  worked  in  a 
factory  only  one  week.  One  of  my  patients 
developed  plumbism  after  eight  days'  work  in  a 
small  room  where  he  was  making  electric  accumu- 
lators   for    a    colliery.     Dr.    Alice    Hamilton,    of 


1 64 


LEAD  POISONING 


Chicago,  found  in  hospital  a  white  lead  worker 
who  had  been  admitted  for  colic  and  neuritis  after 
having  worked  only  three  days.  Her  experience 
of  other  cases  is  equally  interesting.  Of  120 
patients  whom  she  examined,  8  had  become  ill 
in  less  than  two  weeks  after  taking  up  the  work, 
36  in  less  than,  a  month,  and  89  in  less  than  a 
year.  Of  64  bath-enamellers,  1  became  ill  in  less 
than  a  fortnight,  2  in  less  than  one  month,  and  19 
in  less  than  one  year,  while  42  had  worked  more 
than  one  year.  A  house-painter  working  indoors 
and  employed  in  sandpapering  suffered  from  con- 
vulsions at  the  end  of  nine  weeks  ;  for  three  days 
he  lay  in  a  state  of  coma,  recovered  slowly  and 
returned  to  work  at  the  end  of  three  months.  In 
Vorwarts,  1897,  the  following  data  afford  infor- 
mation as  to  the  periods  in  which  symptoms  of 
lead  poisoning  showed  themselves  in  nine  men  who 
were  working  in  a  small  electrical  accumulator 
factory : 

1  man  became  ill  with  colic  after  1*5  weeks. 


I              „              , 

2-5      , 

2                    ,,                   , 

3'5      , 

I                    ,,                   , 

4'5      , 

1                    » 

5'5      . 

I                    ,, 

,              „              6-o      , 

2                   ,,                   , 

7"5      , 

WHAT  AMOUNTS  OF  LEAD  ARE  HARMFUL?    165 

What  Amounts  of  Lead  are  Harmful  ? 

Several  workers  in  the  field  of  industrial  hygiene 
have  attempted  to  throw  light  upon  this  subject. 
From  a  worker's  point  of  view  it  would  be  of 
assistance  to  us  if  we  knew  something  definite  in 
regard  to  this,  but  the  problem  is  surrounded  with 
difficulties.  Experiment  has  therefore  had  to  be 
resorted  to,  most  of  the  lead  being  given  in 
solution  in  drinking-water.  A  little  while  ago  the 
water  of  Berlin  was  found  to  contain  0*3  milli- 
gramme of  lead  per  litre.  This  amount  of  lead 
was  not  productive  of  harm.  Dr.  Angus  Smith 
and  Professor  Rubner  tell  us  that  0*36  milli- 
gramme of  lead  per  litre  of  water  is  the  limit  of 
safety.  After  standing  for  twelve  hours,  if  water 
has  taken  up  from  lead  which  has  been  immersed  in 
it  1  milligramme  of  the  metal  per  litre,  this  amount 
is  believed  to  be  dangerous.  Intoxication  by  lead 
has  been  caused  by  people  drinking  water  which 
/contained  i"6  milligrammes  of  lead  per  litre,  but 
symptoms  have  also  followed  when  the  water 
contained  0*5  milligramme.  Of  38  persons 
living  at  Castle  Clermont,  13  fell  ill  after 
having  used  for  nine  months  water  which  con- 
tained o"2  to  i"5  milligrammes  of  lead.  Teleky 
gives  it  as  his  opinion  that  if  1  milligramme  or  a 
little  more  of  lead  is  taken  daily  for  several  months 


UUl  u 

/  likely 


1 66  LEAD  POISONING 

it  will  cause  plumbism,  and  that  a  daily  dose  of 
10  milligrammes  will  lead  to  serious  intoxication 
after  a  few  weeks.  In  the  instances  just  recorded 
it  ought  to  be  remembered  that  the  lead  was  in  solu- 
tion, and  was  passed  directly  into  the  alimentary 
canal.  The  conditions,  therefore,  do  not  exactly 
compare  with  inhalation  of  lead  dust  in  a  factory. 
Here  we  need  hardly  again  raise  the  question  of 
whether  lead  dust  is  absorbed  directly  from  the 
respiratory  passages  or  from  the  alimentary  canal, 
but  dealing  with  the  latter  as  probably  the  more 
channel,  it  may  be  said  that  ioo  cubic  centi- 
metres of  o'l  normal  hydrochloric  acid  will  dissolve 
10  milligrammes  of  lead  in  a  comparatively  short 
space  of  time ;  during  the  same  period  28  milli- 
grammes of  sulphate  of  lead  will  be  dissolved,  28  of 
sulphide,  and  7*4  of  chromate.  Clearly,  therefore, 
small  quantities  of  lead  can  always  be  readily 
dissolved  in,  and  be  also  readily  absorbed  from,  the 
stomach.  It  is  the  minute  quantities  of  lead  which 
do  harm,  for  larger  quantities  would  be  less  likely 
to  be  dissolved  and  absorbed. 

Without  regarding  these  results  as  in  any  way 
conclusive,  it  may  be  stated  that  the  amount  of 
fume  given  off  into  the  atmosphere  by  molten  lead 
has  been  estimated.  Lead  melts  at  3250  C,  and 
vaporizes  at  about  6500  C,  if  there  is  no  slag  on 
the   surface  to  prevent  the  escape  of  the  oxide. 


WHAT  AMOUNTS  OF  LEAD  ARE  HARMFUL  ?    167 

Tischler  found  2*5  to  9  milligrammes  of  the  metal 
in  100  litres  of  air  removed  from  immediately 
above  the  reservoir  of  molten  lead  attached  to  a 
stereotyping  machine,  and  Kaup  found  in  the  air 
of  the  drying-ovens  in  a  white  lead  factory  taken 
at  the  level  of  the  lips  of  the  workmen,  0*134 
milligramme  of  lead.  Miiller  found  in  the  air  of 
a  lead  smelting  works  236*8  milligrammes  of  lead 
in  100  litres  of  atmospheric  air  at  the  place  where 
the  men  were  working,  and  that  after  a  hood  had 
been  erected  the  air  contained  only  0*29  to  0*56 
milligramme  of  lead  per  100  litres.  If,  as  Teleky 
says,  we  consider  that  4*5  cubic  metres  of  air  are 
taken  into  our  lungs  in  ten  hours — that  is,  during 
an  average  working  day — the  amounts  of  lead 
inhaled  may  be  anything  between  6  and  25*2 
milligrammes.  Kaup  found  in  100  litres  of  air  in 
a  white  lead  factory  0*122  to  0*271  milligramme  of 
lead ;  this,  he  believed,  would  give  5*49  to  12*2  as  v 
the  amounts  of  lead  in  milligrammes  which  might 
be  inhaled  by  workmen  daily.  In  paint  mixing 
and  dry  colour  grinding,  there  may  be  0*178  to  1/ 
0*25  milligramme  of  lead  per  100  litres  of  air.  Men 
exposed  to  such  quantities  of  lead  can  hardly 
escape  becoming  lead-poisoned.  When  we  add 
to  the  possibility  of  harm  arising  from  breathing  a 
dusty  atmosphere  that  arising  during  eating  from 
the   soiled   hands   of    the   workmen,    the   danger 


168  LEAD  POISONING 

becomes  greater,  for  M  tiller,  at  the  close  of  a 
working  day,  obtained  from  the  hands  of  men 
employed  in  lead  smelting  works  07  milligramme, 
ii"28  milligrammes,  and  even  as  much  as  643  milli- 
grammes of  lead.  Such  quantities  of  lead  adhering 
to  the  hands  of  workmen  show  the  necessity  there 
is  for  workmen  to  wash  carefully  before  taking  food. 
Additional  information  bearing  upon  the  question 
of  the  amount  of  lead  required  to  cause  plumbism 
has  also  been  obtained  from  experimenis  upon 
animals.  Walter  Straub,*  of  Freiburg,  in  co- 
operation with  Erlenmeyer,  made  experiments 
with  cats  and  rabbits.  Straub  injected  freshly 
precipitated  lead  carbonate  under  the  skin  of  the 
back  of  a  rabbit  on  September  1,  1908.  On 
November  7  the  animal  remained  well,  but  after 
this  date  there  gradually  developed  paralysis  of  the 
fore-limbs,  and  subsequently  spastic  paralysis  of 
the  hind-limbs,  especially  of  the  abductor  muscles  ; 
the  hair  fell  off,  and  the  skin  atrophied,  but  the 
animal  retained  its  weight.  It  died  on  January  3, 
1909,  124  days  after  having  received  the  injection 
of  lead.  At  the  autopsy  Straub  found  at  the  site 
of  the  injection  a  considerable  quantity  of  unab- 
sorbed  lead.  Cats  similarly  treated  died  in  seven 
to  twelve  weeks  after  the  injection  from  bulbar 

*  Mnenchener   Medizin,    Wochenschrifi,   January  6,  1914, 
P-  5. 


WHAT  AMOUNTS  OF  LEAD  ARE  HARMFUL?    169 

paralysis,  preceded  by  loss  of  weight.  Professor 
Ascher  made  microscopical  sections  of  the  organs 
of  the  cats  poisoned  by  Straub  and  Erlenmeyer. 
He  found  pathological  changes  in  the  spinal  cord. 
There  was  an  intense  cellular  infiltration  of  Goll's  ^ 
and  Burdach's  columns.  The  blood  of  the 
animals  was  examined  by  Professor  H.  Schridde, 
but  not  in  the  blood  of  one  of  them  did  he 
find  the  basophile  red  corpuscles  which  are 
regarded  by  some  physicians  as  pathognomonic  of  ^ 
plumbism.  In  the  eight  to  ten  weeks  during  which 
the  animals  lived  after  the  injection,  Straub  found 
that  o'l  to  o-2  gramme  of  lead  had  been  absorbed, 
admittedly  a  minute  quantity  to  be  capable  of  caus- 
ing such  an  amount  of  harm.  Straub  observed  that 
all  through  the  experiment  lead  was  being  thrown 
out  of  the  body  by  the  urine.  His  opinion  is  that 
at  any  particular  period  traces  only  of  lead  are 
retained  in  the  organism,  that  there  is  never  any 
large  accumulation  of  lead,  and  that,  as  already 
mentioned,  it  is  the  heaping-up  of  the  minute 
injuries  inflicted  upon  the  body  by  such  delicate 
quantities  which  are  the  cause  of  plumbism. 
From  the  site  at  which  the  injection  had  been 
made,  a  current  of  measurable  quantity  of  lead 
keeps  passing  through  the  animal.  It  would  be 
important  to  know  the  actual  amount  of  lead 
injected    into   an    animal,    the    amount    of    lead 


i7o  LEAD  POISONING 

eliminated  daily  in  the  urine  during  the  period  of 
the  experiment,  also  on  cremating  the  animal  after 
death  the  amount  which  had  been  left  in  the  body. 
This  would  give  an  approximate  idea  of  the 
amount  of  lead  capable  of  giving  rise  to  plumbism. 
Erlenmeyer  attempted  to  do  this  and  he  concluded 
that  gg  per  cent,  of  the  lead  lost  from  the  deposit 
at  the  site  of  injection  in  the  back  of  the  animal 
could  be  accounted  for  by  having  been  elimi- 
nated in  the  urine,  and  what  remained  in  the 
ash  of  the  body  after  death.  Erlenmeyer  found 
that  plumbism  was  fatal  if  o-o6  gramme  of  lead  per 
kilo  of  body-weight  passed  daily  for  sixty  days 
through  the  animal.  He  gives  as  the  formula  for 
fatal  lead  poisoning  in  the  cat  per  kilo  of  animal : 

lead  carbonate 

60  days  =  0*00004  gramme  hours, 

that  is,  iinnnro  part  °f  a  gramme  of  lead  must  pass 
per  hour  through  each  1  kilo  weight  of  animal 
in  order  to  be  fatal.  In  other  words  a  cat  dies 
from  bulbar  lead  paralysis  if  an  intensity  of  lead 
current  equal  to  0*00004  gramme  of  lead  flows 
through  each  kilo  of  its  body-weight  per  hour 
for  sixty  days.  An  effort  has  thus  been  made  to 
determine  the  amount  of  lead  capable  of  producing 
in  animals  organic  disease  of  the  central  nervous 
system  by  means  of  lead.  The  above  can  only  be 
regarded  as  an  approach  to  a  solution  of  an  impor- 


WHA T  A  MOUNTS  OF  LEA D  ARE  HA RMFUL  ?    171 

tant  problem.  Bulbar  paralysis  is  in  man  a  rare 
form  of  industrial  plumbism,  but  the  fact  remains 
that  there  are  forms  of  paralysis  and  other  signs  of 
degeneration  of  the  central  nervous  system  in  man 
due  to  chronic  lead  poisoning  which  have  hitherto 
escaped  recognition,  on  account  of  their  atypical 
nature,  and  the  absence  of  the  usual  accompani- 
ments of  plumbism. 

Lead  absorbed  into  the  system  cannot  circulate  / 
in  the  blood  without  inflicting  injury  upon  such  of 
the  eliminating  organs  as  the  kidneys  and  liver. 
If  it  leaves  the  blood  for  the  tissues  it  passes  into 
stable  combination  with  their  proteids.  In  the 
tissues  it  may  remain  in  the  comparatively  insoluble 
form  of  albuminate.  Under  circumstances  which 
we  can  neither  foresee  nor  explain,  but  of  which  / 
the  influence  of  potassium  iodide,  is  an  illustration, 
the  lead  albuminate  stored  in  the  tissues  may 
become  redissolved,  and  on  being  reabsorbed  into 
the  blood  may  again  induce  symptoms  of  plumbism. 
In  the  intestine  of  patients  who  have  died  from 
lead  poisoning,  and  equally  in  animals  the  subjects 
of  experimental  plumbism,  bluish-black  patches 
are  occasionally  observed  in  the  mucous  mem- 
brane due  to  a  deposit  of  lead  sulpWle.  As  the 
patients  in  whom  I  have  seen  these  patches  had 
been  the  subjects  of  obstinate  constipation,  it 
seemed  as  if  these  patches  were  situated  at  those 


172  LEAD  POISONING 

parts  of  the  alimentary  canal  where  the  faeces  had 
lain  longest  in/contact  with  the  intestinal  mucous 
membrane,  v  Since  it  is  primarily  to  the  liver  that 
lead  absorbed  by  the  intestinal  veinules  is  carried, 
it  is  in  this  organ  that  we  look  for  structural 
alterations ;  but  although  after  death  the  largest 
amounts  of  lead  are  usually  found  in  the  liver,  the 
changes  of  structure  in  that  organ  are  as  a  rule 
less  pronounced  than  they  are  in  the  Uodneys. 
On  microscopical  examination  the  liver  cells  may 
be  found  atrophied,  they  may  have  undergone 
fatty  degeneration,  or  there  may  be  an  increase  of 
the  interstitial  tissue,  such  as  to  recall  a  mild  form 
l/  of  cirrhosis  of  the  liver.  The  cirrhosis  may  be  ^ 
intercellular  or  interlobular.  In  a  female  who 
died  from  plumbism,  the  result  of  drinking  water 
contaminated  by  lead,  there  was  marked  fatty 
infiltration  as  well  as  fatty  degeneration  of  the 
liver,  while  in  the  same  organ  of  an  infant  who 
died  two  weeks  after  birth,  whose  parents  were  both 
lead  workers,  there  was  atrophy  of  the  liver  cells  / 
with  marked  increase  of  the  interlobular  tissue.       ' 

To  the  role  of  the  liver  in  saturnine  poisoning 
fresh  interest  is  attached  through  the  experiments 
of  MM.  A.  Roncato*  and  P.  D.  Siccardi,  who 
submitted  healthy  dogs  to  injections  of  neutral 
acetate  of  lead.     On  comparing,  microscopically, 

*  Archivio  di  Fistologta,  1913. 


WHAT  AMOUNTS  OF  LEAD  ARE  HARMFUL?  173 

sections  of  the  liver  of  these  dogs  with  those  of 
healthy  animals,  they  found  numerous  black 
granules  in  the  cells  of  Kupfer  which  are  not 
present  in  the  same  cells  in  healthy  dogs.  Ron- 
cato  and  Siccardi  are  of  the  opinion  that  the 
black  granules  are  essentially  metallic  lead,  that 
hepatic  cells  are  capable  of  reducing  salts  of  lead, 
and  that  they  have  the  power  of  fixing  the  metal. 
Thus  may  be  explained  some  of  the  peculiarities 
of  plumbism.  Lead  poisoning  not  only  develops 
slowly,  but  long  after  a  man  or  woman  has  retired 
from  a  lead  works  and  has  ceased  to  be  absorbing 
the  poison,  plumbism  may  yet  develop.  Such 
attacks  of  plumbism,  always  with  difficulty  ex- 
plained, may  be  due  to  the  fact  that  under  certain 
conditions  the  hepatic  cells  had  temporarily  lost 
the  power  of  retaining  the  lead  which  was  lying 
reduced  in  the  interior  of  the  cells. 

Of  all  the  internal  organs  the  kidneys  are 
perhaps  those  in  which  structural  changes  are 
most  marked.  Because  interstitial  nephritis  or 
contracted  kidney  is  the  most  common  patho- 
logical event  in  chronic  plumbism,  this  has  come 
to  be  regarded  as  the  typical  renal  lesion  of  lead 
poisoning.  It  is  undoubtedly  the  lesion  of  chronic 
lead  poisoning  ;  it  is  found  in  persons  who  have 
worked  in  lead  for  years.  As  an  accompaniment 
there  is  frequently  widespread  thickening  of  the 


174  LEAD  POISONING 

small  arteries.  Long  before  the  kidney,  however, 
has  undergone  structural  change,  its  function 
may  have  been  deranged,  for  albuminuria  may 
be  met  with  in  the  early  stages  of  plumbism. 
Albuminuria  may  occur  during  an  attack  of  colic ; 
it  may  disappear  under  treatment  and  return  again 
during  another  attack  of  colic.  I  have  seen 
albuminuria  develop  almost  immediately  in  lead 
workers  after  the  administration  of  potassium 
iodide,  and  just  as  rapidly  disappear  on  cessation 
of  the  medicine.  Where  a  lead  worker  dies  from 
acute  plumbism  after  having  been  employed  for 
only  a  few  weeks  or  months  in  a  factory,  the 
lesion  in  the  kidney  is  not  interstitial  but  tubal. 
The  renal  epithelial  cells  are  swollen  ;  they  are 
the  seat  of  cloudy  swelling  or  of  fatty  granular 
degeneration.  The  cells  break  down  and  fill  the 
tubules  with  debris.  Inside  the  glomeruli  there  may 
be  evidence  of  cellular  proliferation,  whilst  leuco- 
cytes may  be  gathered  around  the  afferent  vessels. 
In  the  early  stages  of  lead  intoxication,  there- 
fore, as  might  be  expected  from  the  fact  that  the 
kidneys  are  important  organs  of  elimination  of 
lead,  the  renal  epithelia  and  glomeruli  suffer  most, 
a  circumstance  which  explains  some  of  the 
nervous  accidents  which  occur  in  the  early  stages 
of  the  malady,  and  which  are  the  combined  result 
of  auto-toxis  and  plumbism.  Bouchard  drew 
attention  to  the  fact  that  if  the  urine  of  a  lead 


WHAT  AMOUNTS  OF  LEAD  ARE  HARMFUL  ?  175 

worker  who  is,  comparatively  speaking,  in  good 
health  is  injected  into  an  animal,  it  seems  to 
possess  highly  toxic  properties,  for  the  animals 
become  convulsed  ;  but  if  the  urine  removed  from 
the  bladder  of  a  lead  worker  who  is  suffering  from 
convulsions  is  similarly  injected,  it  is  found  to 
have  lost  most  of  its  toxic  power  owing  to  the 
poison  or  poisons  being  retained  within  the  body 
and  blood  of  the  patient.  In  other  words,  the 
convulsive  seizure  would  be  a  sign  that  lead  was 
not  being  eliminated. 

Only  once  have  I  found  hsematoporphyrin 
present  in  the  urine  in  lead  poisoning.  For  its 
detection  the  spectroscope  must  be  resorted  to. 
Steinberg  holds  that  hsematoporphyrinuria  is  due 
to  small  haemorrhages  in  the  intestine. 

Salivary  glands  eliminate  lead.  In  the  saliva  ot 
some  of  my  patients  to  whom  I  had  administered 
pilocarpin,  Professor  Bedson  found  3  parts  of  lead 
per  million.  In  the  mucus  which  escaped  from 
the  nostrils  of  a  rabbit  undergoing  the  double 
electrical  bath  treatment  Clague  found  lead. 

Judging  from  the  conditions  observed  in  chronic 
plumbism  lead  exercises  little  effect  upon  the 
heart  unless  through  the  intervention  of  the 
bloodvessels. 

It  is  hardly  to  be  expected  that  symptoms  of 
lead  poisoning  will  develop  until  absorption  of  the 
metal  has  for  a  period  exceeded  its  elimination, 


176  LEAD  POISONING 

and  even  then  it  is  not  uncommon  for  some 
persons  to  go  on  working  in  a  factory  apparently 
in  good  health  until  something  happens  such  as 
illness,  or  excessive  drinking  is  indulged  in,  where- 
by the  functional  activity  of  the  internal  organs 
becomes  temporarily  deranged. 

Lead  and  Female  Life. 

Apart  from  individual  and  family  idiosyncrasy 
there  is  a  sexual  predisposition  to  lead.  On  the 
whole,  females,  particularly  young  females,  suffer 
more  severely  from  plumbism  than  males.  This 
is  largely  the  result  of  the  disturbance  of  their 
menstrual  life.  In  some  persons  amenorrhcea 
follows  exposure  to  lead,  in  others  there  is  exces- 
sive menstruation.  The  severe  headache  experi- 
enced by  females  exposed  to  lead  may  therefore 
be  a  direct  consequence  of  the  action  of  lead,  or 
indirectly  the  result  of  menstrual  derangement. 

Lead  and  Motherhood. 

Since  1898,  or  thereabouts,  the  year  in  which,  in 
consequence  of  Home  Office  regulations,  females 
ceased  to  work  in  the  dangerous  processes  of  lead 
manufacture,  but  to  whom  was  still  permitted  such 
work  as  the  making  up  of  blue  beds,  and  the 
washing  of  the  men's  overalls,  bath-towels,  etc., 


LEAD  AND  MOTHERHOOD  177 

the  number  of  cases  of  plumbism  in  females  has 
considerably  decreased.  It  was  the  large  number 
of  cases  of  plumbism,  many  of  them  rapidly  fatal 
in  young  women,  which  led  to  the  abolition  of 
female  labour  in  dangerous  processes.  In  potteries 
women  are  still  allowed  to  work  where  glaze  con- 
taining lead  in  small  quantities  is  used.  Taking  the 
pottery  statistics  for  1898,  there  were  3,123  men  em- 
ployed in  lead  processes  in  North  Staffordshire.  Of 
these  152,  or  4*9  per  cent.,  suffered  from  plumbism, 
while  of  1,580  women  similarly  employed,  196,  or 
12*4  per  cent.,  suffered.  Of  12  deaths  from 
plumbism  11  occurred  in  females.  In  the  Annual 
Report  of  the  Chief  Inspector  of  Factories,  1912, 
the  cases  of  reported  lead  poisoning  per  1,000 
persons  employed  are  for  males  11,  and  for 
females  19  ;  but  when  some  of  the  occupations  are 
taken  separately — e.g.,  that  of  dippers'  assistants, 
in  which  both  males  and  females  are  together 
employed — the  cases  of  lead  poisoning  are  for 
males  8,  and  for  females  19,  and  for  ware  cleaners, 
males  11,  and  females  35.  Previous  to  the 
exclusion  of  females  from  the  dangerous  processes 
in  lead  works  there  occurred,  over  a  period  of  a 
few  years,  in  Newcastle-upon-Tyne,  23  deaths 
from  plumbism,  of  which  22  were  of  females. 

My  contention  is  that  it  is  largely  owing  to  the 
power  of  lead  to  inflict  harm  upon  the  reproduc- 

12 


178  LEAD  POISONING 

five  organs  of  women  that  the  female  sex  is  so 
liable  to  be  adversely  influenced  by  the  metal.  In 
./consequence  of  its  ecbolic  action  it  is  difficult  for 
pregnant  females  to  proceed  to  term  if  they  remain 
at  work  in  the  factory.  They  are  almost  certain 
to  miscarry  and  to  have  either  a  stillborn  infant, 
or  the  child,  if  it  is  born  alive,  dies  in  convulsions 
a  few  hours  or  days  after  birth.  The  only  means 
by  which  I  succeeded  in  getting  lead  workers 
who  had  miscarried  six  or  seven  times  in  succes- 
sion, when  again  pregnant,  to  reach  term  was  by 
keeping  them  off  work.  The  following  cases  bear 
upon  these  points.  Some  of  them  are  now  old 
infirmary  patients  of  many  years  ago. 

Mrs.  K.,  aged  thirty-four,  had  four  children 
before  going  into  the  lead  works,  and  two  chil- 
dren in  the  early  part  of  her  lead  career  after- 
wards. Continuing  at  her  employment  she  had 
six  miscarriages  in  succession.  After  the  last 
miscarriage  she  was  admitted  into  the  infirmary 
under  my  care,  suffering  from  paralysis  of  arms 
and  legs  due  to  lead.  She  made  a  slow  but  com- 
plete recovery.  Acting  upon  my  advice,  she  did 
not  return  to  the  factory.  In  her  next  pregnancy 
she  went  to  term  and  bore  a  living  child. 

Mrs.  A.,  aged  forty,  was  a  lead  worker  for 
several  years.  She  has  had  eight  children,  all  of 
whom  died  in  convulsions. 

Mrs.  C,  aged  twenty-four,  until  a  little  while 


LEAD  AND  MOTHERHOOD  179 

ago  lived  on  a  farm,  where  she  gave  birth  to  a 
healthy  infant.  Four  months  previously  to  seeing 
me  she  had  taken  up  work  in  a  white  lead  factory. 
Within  three  months  she  miscarried. 

Mrs.  E.  A.,  aged  forty-six,  had  three  children 
before  going  into  a  white  lead  factory.  These 
children  are  still  alive.  After  she  became  a  lead 
worker  she  had  nine  children,  all  of  whom  died 
before  the  age  of  four  months.  She  gave  up  work 
in  the  factory,  and  in  due  course  gave  birth  to  a 
healthy  child,  who  at  the  time  of  writing  is  still 
alive. 

Mrs.  E.  W.,  aged  fifty- nine,  worked  in  a  lead 
factory  all  her  married  life.  She  had  ten  children, 
nine  of  whom  died  under  three  years  of  age.  The 
surviving  child  is  undersized,  ill-developed  phsyi- 
cally,  and  is  weak  mentally. 

Mrs.  W-,  aged  sixty-six,  worked  twenty-two 
years  in  a  white  lead  factory.  She  suffered  from 
convulsions.  She  had  six  miscarriages  and  ten 
children  born  alive.  Five  of  the  children  died  in 
the  early  months  of  infancy  in  convulsions.  One 
of  the  remaining  five,  a  daughter,  Mrs.  L.,  aged 
thirty-seven,  was  also  for  several  years  a  lead 
worker.  She  had  on  one  occasion  before  her 
marriage  severe  colic.  Mrs.  L.  has  had  one  still- 
born child,  one  miscarriage,  and  four  children,  all 
of  whom  are  alive  and  healthy. 

Of  thirty-six  women,  formerly  white  lead  workers, 


180  LEAD  POISONING 

who  have  come  under  my  notice,  the  following 
are  the  results  of  their  pregnancies — 294  in  all : 

51  miscarriages, 

16  stillbirths, 

104  infants  died  shortly  after  birth, 

17  infants  died  within  a  few  years  of  birth — 

a  total  of  188  early  fatal  results,  and  of  106  living 
children. 

An  interesting  point  in  regard  to  maternity  and 
plumbism  is  that,  while  an  expectant  mother  does 
not  show  any  sign  of  plumbism,  and  is  apparently 
not  suffering  from  lead  poisoning,  she  transmits  to 
her  babe  such  a  legacy  of  lead  that  the  infant  is 
born  dead,  or  dies  shortly  after  birth.  The  same 
thing  is  observed  in  animals.  In  the  case  of  one  of 
my  laboratory  rabbits  who  had  received  lead  during 
pregnancy,  two  of  her  litter  of  nine  died  within 
two  days  after  birth,  and  from  the  body  of  each  of 
these  animals  Mr.  T.  M.  Clague,  analytical 
chemist,  recovered  TV  grain  of  lead.  Yet  the 
mother  rabbit  was  quite  well  and  did  not  suffer 
from  lead  poisoning  at  all.  When  women  worked 
in  the  white  lead  factories  of  Newcastle,  they 
maintained  that  child-bearing  relieved  them  of 
the  risks  of  becoming  lead-poisoned,  for  they 
passed  on  the  lead  to  the  foetus  in  utero.  The 
infant  died,  but  the  mother's  body  had  parted  with 
lead.     The  placenta  allows  of  soluble  lead  com- 


LEAD  AND  MOTHERHOOD  1S1 

pounds  to  osmose  from  the  maternal  into  the  foetal 
blood,  to  be  retained  in  the  body  of  the  foetus,  to  in- 
duce structural  changes  therein,  and  to  destroy  life. 

I  have  given  in  detail  some  of  my  experience  of 
lead  poisoning  and  maternity.  It  is  to  M.  Paul, 
a  French  physician,  we  are  indebted  for  much 
that  we  know  of  this  subject.  He  tells  us  that 
of  fifteen  pregnancies  of  four  women  who  had 
worked  in  a  type-foundry,  ten  ended  in  abortion, 
two  in  premature  labour,  one  in  stillbirth,  and 
one  child  died  within  twenty-four  hours  of  its 
birth.  In  another  series  five  women  had  given 
birth  to  nine  children  before  working  in  lead 
without  one  abortion.  After  exposure  to  lead 
there  was  a  total  of  thirty-six  pregnancies :  of 
these  twenty-six  ended  in  abortion,  one  in  pre- 
mature labour,  two  in  stillbirths,  five  children 
died,  four  of  them  in  the  first  year  of  life. 

Not  only  has  working  in  lead  a  disastrous  effect 
upon  pregnancy,  it  would  almost  seem  as  if 
pregnancy  itself  predisposed  to  plumbism.  Teleky 
relates  the  following  :  F.  T.,  aged  seventeen  years, 
a  polisher,  worked  in  a  bottle-stop  factory  from 
March,  1907,  to  July,  1907,  without  being  ill. 
Later  on,  becoming  pregnant,  she  continued  to 
follow  her  occupation  from  March  10,  1908,  until 
May  13,  1908.  From  May  13  to  June  13,  1908, 
she   suffered   from   plumbism.     On   June   23    her 


i8a  LEAD  POISONING 

child  was  born  prematurely,  and  lived  for  only 
seven  weeks.  She  made  a  good  recovery,  and 
returned  to  the  factory,  where  she  worked  from  the 
middle  of  August,  1908,  until  October  9,  1908, 
when  she  again  broke  down  in  health  from 
plumbism.  F.  T.  remained  off  work  until  Decem- 
ber 28,  1908,  when  she  returned  to  the  factory 
and  followed  her  occupation  until  February  10, 
1909,  when  she  again  suffered  from  lead  poisoning, 
had  a  marked  blue  line  on  the  gums,  was  extremely 
anssmic,  and  altogether  seemed  seriously  ill.  In 
the  latter  half  of  the  month  of  March — that  is, 
fully  one  month  after  having  left  the  factory — 
she  developed  paralysis  of  both  hands  and  slight 
paralysis  of  the  feet.  The  paralysis  of  the  feet 
improved,  but  in  1910  the  hands  were  still  helpless. 
It  was  not  until  19 n  that  the  hands  had  improved. 
The  above  is  the  case  of  a  young  woman 
seventeen  years  of  age,  who  had  worked  in  a  lead 
process  for  four  months  with  good  health.  In 
\/  the  following  year,  when  enceinte,  she  works  for 
two  months,  when  she  has  lead  poisoning.  The 
infant  born  alive  dies  within  seven  weeks.  Mean- 
while, the  mother  returns  to  work  as  a  polisher, 
and  follows  her  employment  for  two  months, 
when  she  is  obliged  to  give  up  work  for  ten  weeks 
on  account  of  lead  intoxication,  from  which  she 
recovers    sufficiently   to    return    to    work    for    six 


LEAD  AND  MOTHERHOOD  183 

weeks,  when  she  breaks  down  in  health  and 
develops  a  few  weeks  afterwards  a  form  of 
paralysis  from  which  she  had  not  recovered  a  year 
afterwards.  In  this  particular  instance  Teleky 
was  of  the  opinion  that  pregnancy  had  exaggerated 
the  susceptibility  to  plumbism. 

In  these  remarks  I  have  dealt  with  the  harmful 
influence  of  lead  upon  the  product  of  conception 
where  the  mother  alone  has  been  exposed  to  lead. 
As  illustrating  the  injurious  effects  upon  the 
progeny  when  the  father  is  working  in  lead,  I  fall 
back  upon  information  supplied  by  Dr.  Carozzi, 
of  Milan.  Of  455  pregnancies  of  women  whose 
husbands  were  type-smelters,  277  ended  in  living 
births,  117  in  stillbirths,  and  in  67  instances 
in  miscarriages.  Among  women  working  at  the 
lead  mines  in  Sardinia,  most  of  them  being 
employed  in  the  smelting-shop,  1,483  pregnancies 
occurred ;  829  children  were  born  alive,  there 
were  326  stillbirths,  and  326  miscarriages ;  whilst 
199  pregnant  wives  of  men  working  at  the  mines 
bore  36  living  children,  had  108  stillbirths,  and  55 
miscarriages.  V  Lead  clearly  exercises,  therefore,  a  / 
deleterious  influence  upon  the  seminal  fluid  of 
the  male.  Professor  Lewin,  of  Berlin,  tells  us 
that  of  seven  women  married  to  men  working  in 
lead  all  of  them  gave  a  history  of  miscarriages. 
Of  ^2   pregnancies   only   2    living    children    were 


1 84  LEAD  POISONING 

born.  In  colour  works  in  which  lead  was 
used,  Carozzi  found  with  saturnine  fathers  48*4 
per  cent,  of  living  children,  37*2  per  cent,  of  still- 
births, and  14*4  per  cent,  of  miscarriages,  or  a  total 
death  and  miscarriage  rate  of  51*6  per  cent. ;  while 
Frogia  found  the  numbers  to  be  respectively  18, 
54-4,  and  27*6  per  cent.,  or  a  total  of  82  per  cent, 
death  and  miscarriage  rate  where  the  fathers 
worked  in  lead,  while  as  regards  saturnine  mothers 
the  infant  death  and  miscarriage  rate  was  44*1  per 
cent. 

Contrary  to  my  own  experience  and  that  of 
many  other  physicians,  Carozzi  and  Frogia  are  of 
the  opinion  that  the  influence  upon  progeny  of  a 
father  who  has  been  employed  in  lead  is  even 
greater  than  that  of  an  expectant  mother  who  had 
been  similarly  exposed.  In  opposition  to  this, 
Rennet  states  that  where  the  mother  alone  is 
exposed  to  lead  the  conception  is  damaged  in 
92  percent.,  and  in  paternal  saturnism  the  damage 
is  63  per  cent. 

Where  both  parents  work  in  lead  the  effect 
upon  offspring  is  much  greater  than  where  only 
one  of  them  is  employed.  Lead  is  a  racial  poison  ; 
it  destroys  the  foetus  in  utero  directly,  or  it  cuts 
short  its  stay  in  the  womb  by  its  action  upon 
uterine  muscular  fibre. 


BLOOD-PRESSURE  EXPERIMENTS  185 

Blood-Pressure  Experiments. 

Before  discussing  the  question  of  lead  poisoning 
and  blood  pressure,  let  us  see  what  happens  when 
lead  is  directly  introduced  into  the  blood  stream. 
With  the  view  of  ascertaining  upon  which  organ 
or  organs  of  the  body  lead  primarily  acts  when 
administered  intravenously,  I  carried  out  a  series 
of  experiments,  in  which  I  was  ably  assisted  by 
my  colleague,  Professor  R.  A.  Bolam,  to  whom  I 
gratefully  acknowledge  my  indebtedness. 

In  pharmacological  textbooks  lead  is  spoken  of 
as  a  specialized  poison  for  most  of  the  tissues  and 
organs  of  the  body,  and  is  said  to  be  a  general 
poison  to  protoplasm.  Its  effects  are  observed 
more  upon  the  highly  developed  tissues,  such  as 
muscle  and  nerve,  than  upon  blood,  although  we 
know  that  in  time  the  blood  becomes  affected  also. 
Lead  is  said  to  act  upon  muscle  fibre  and  to  pro- 
duce fatigue.  It  certainly  acts  upon  unstriped 
muscle  fibre,  as  illustrated  by  forcible  emptying  of 
the  pregnant  uterus  and  its  constricting  effect 
upon  the  small  arteries.  Riegel  found  the  blood 
pressure  heightened  in  lead  colic,  but  in  many  of 
my  own  cases  the  pulse  was  small  and  feeble,  and 
the  heart's  beat  so  weak  that  the  sounds  were 
practically  inaudible. 

With  the  view,  therefore,  of  clearing  up  some 


186  LEAD  POISONING 

doubtful  points,  Professor  Bolam  and  I  undertook 
the  following  experiments,*  which  consisted  in  the 
intravenous  injection  of  varying  quantities  of  solu- 
tions of  nitrate  of  lead  into  dogs  anaesthetized  by 
chloroform  or  ether.  When  5  cubic  centimetres 
of  distilled  water  were  injected  into  the  vein  of 
a  dog,  no  effect  was  produced  on  the  arterial 
pressure.  The  injection  of  5  cubic  centimetres  of 
a  1  per  cent,  solution  of  lead  nitrate  was  followed 
shortly  afterwards  by  a  slight  fall  of  blood 
pressure.  Five  cubic  centimetres  of  a  2  per  cent, 
solution  were  also  followed  by  a  slight  fall,  which 
in  each  instance  was  quickly  recovered  from. 
After  an  injection  of  10  cubic  centimetres  of  a 
10  per  cent,  solution  and  recovery  from  a  pro- 
nounced fall  of  arterial  pressure,  a  second  injection 
of  the  same  quantity  and  strength  of  nitrate  of 
lead  was  succeeded  by  a  rapid  declension  of 
pressure  and  stoppage  of  the  beat  of  the  heart. 
Respiration  continued.  After  an  interval  of  from 
three  to  four  minutes  the  heart  recovered  itself ; 
the  beats  returned  feebly  at  first,  and  becoming 
stronger,  they  gradually  reached  the  normal.  In 
consequence  of  a  further  injection  of  5  cubic 
centimetres   of    a    10    per    cent,    solution,    there 

*  "  Some  Unusual  Features  of  Lead  Poisoning."  By 
Thomas  Oliver,  M.D.  A  lecture  delivered  at  the  Polyclinic 
in  London,  May  19,  1909.  The  Hospital,  May  29  and 
June  5,  1909. 


BLOOD-PRESSURE  EXPERIMENTS  187 

occurred  a  fresh  decline  in  the  arterial  pressure  of 
brief  duration,  but  on  injecting  a  double  quantity 
of  a  double  strength  of  lead  nitrate  solution  the 
blood  pressure  rapidly  fell,  and  to  an  extreme 
degree,  although  respiration  continued.  Several 
struggling  beats  of  the  heart  occurred,  and  the 
respiration  became  interrupted.  By  degrees  the 
heart  stopped  beating  ;  respiration  also  ceased. 
At  the  autopsy  twenty-four  hours  afterwards  the 
urine  was  found  free  from  albumin,  but  it  con- 
tained a  reducing  substance  which  acted  upon 
Fehling's  solution.  The  wall  of  the  heart  was 
flabby,  especially  that  of  the  right  ventricle.  The 
right  ventricle  contained  a  small  quantity  of  dark- 
coloured  blood.  Lungs  were  healthy,  the  abdom- 
inal veins  were  full  and  tense,  kidneys  appeared 
to  be  congested,  the  liver  was  dark  but  healthy, 
and  the  brain  was  slightly  congested  on  the 
surface,  although  on  section  pale  internally. 

By  a  male  dog,  into  whose  veins  5  cubic  centi- 
metres of  a  5  per  cent,  solution  of  lead  nitrate 
were  slowly  injected,  and  whose  blood  pressure 
had  been  gradually  restored  after  the  primary  fall, 
amyl  nitrite  was  inhaled,  the  result  being  a  fresh 
fall  of  arterial  pressure.  On  recovery  of  this  the 
effect  of  a  renewed  injection  of  lead  nitrate  solution 
was  a  rapid  fall  of  blood  pressure  with  a  rise  of  the 
respiratory  curve,  possibly  the  result  of  stimulation 


1 88  LEAD  POISONING 

of  the  respiratory  centre  through  want  of  blood. 
The  beat  of  the  heart  and  the  respiratory  move- 
ments ceased,  but  spontaneous  attempts  at  respira- 
tion were  renewed  at  intervals  of  two  to  four 
minutes,  after  which  they  ceased,  the  beat  of  the 
heart  never  having  been  re-established.  At  the 
autopsy  nothing  specially  was  found,  except  that 
the  heart  was  filled  with  fluid  blood  and  the 
abdominal  veins  were  turgid. 

Whether  the  animal  made  use  of  in  these 
experiments  was  a  rabbit  or  a  dog,  the  effects  of 
the  intravenous  injection  of  a  solution  of  lead 
nitrate  were  invariably  the  same — viz.,  a  general 
fall  of  blood  pressure.  This  occurred  equally  in 
the  splanchnic  area  as  in  the  general  systemic 
vessels.  In  the  splanchnic  area  it  was  gradual, 
but  yet  on  the  whole  fairly  rapid.  The  heart 
would  stop,  but  the  beat  might  be  recovered. 

The  effect  of  lead  salts  carried  directly  into 
the  blood  stream  is  upon  the  heart  and  vasomotor 
centre ;  the  fall  and  subsequent  rise  of  arterial 
pressure  occur  simultaneously  in  the  systemic  and 
splanchnic  vessels.  Respiration  is  not  directly 
affected  by  lead ;  it  is  only  indirectly  affected 
through  the  falling  blood  pressure.  One  of  the 
noticeable  effects  of  the  continuation  of  respiration 
is  the  re-establishment  of  the  beats  of  the  heart. 

In  reviewing  the  results  of  the  injection  of  lead 


BLOOD  PRESSURE  AXD   WORKING  IX  LEAD    189 

into  the  venous  system,  it  cannot  be  said  that 
there  is  any  striking  uniformity  in  regard  to  the 
amount  of  lead  required  to  cause  death.  It  is 
known  that  some  men  and  women  are  less  liable 
to  be  affected  by  lead  than  others.  There  is  a 
personal  idiosyncrasy.  In  animals  experimented 
upon  no  difference  as  to  susceptibility  was  noticed 
between  males  and  females.  The  previous  injec- 
tion of  atropine  had  not  the  slightest  influence  in 
altering  the  effect  of  lead  upon  the  heart  or  of 
preventing  the  fall  of  arterial  pressure. 

The  accompanying  tracings  illustrate  the  effects 
of  lead  upon  the  heart  and  circulation. 

Blood  Pressure  and  Working  in  Lead. 

During  attacks  of  lead  colic  Riegel  found  the 
blood  pressure  heightened,  a  circumstance  to 
which  he  was  disposed  to  attribute  the  abdominal 
pain,  believing  that  the  arteries  of  the  splanchnic 
area  were  constricted.  Some  of  the  cerebral 
symptoms,  too,  he  thought,  might  be  explained 
by  a  similar  state  of  the  vessels  of  the  brain 
followed  by  localized  cedema  through  increased 
permeability  of  the  capillary  walls.  Rambousek 
differentiates  between  the  symptoms  which  arise 
in  the  early  stages  of  plumbism,  and  those  met 
with  in  the  chronic  forms  of  the  malady  in  which 
structural  changes  have  already  been  established 


igo  LEAD  POISONING 

During  the  later  stages  of  colic  the  radial  pulses 
are  frequently  unequal.  There  is  an  opinion  that 
work  in  lead  tends  to  raise  the  arterial  pressure. 
Dr.  Edgar  Collis  found  the  average  blood  pressure 
of  141  lead-smelters  to  be  148*2  millimetres  Hg, 
and  of  38  white  lead  workers  156.  In  one  of  the 
white  lead  factories  in  Newcastle-upon-Tyne,  all 
the  men  who  apply  for  work  are  submitted  to  a 
blood-pressure  test.  A  sphygmogram  is  taken. 
Every  workman  with  an  arterial  tension  above 
140  millimetres  Hg  is  rejected.  On  examining 
the  sphygmographic  tracings  of  eighty-four  men 
taken  when  they  commenced  work  and  compar- 
ing them  with  the  tracings  taken  after  a  year's 
service  in  the  factory,  considerable  variations  are 
observed,  but  there  is  no  absolute  uniformity. 
In  one  man  who  had  a  blood  pressure  of  126 
when  he  commenced  work,  the  pressure  rose  a 
few  months  afterwards  to  134,  and  then  gradu- 
ally fell  to  112.  I  have  not  observed  a  con- 
tinued rise  of  blood  pressure  in  the  early  part  of 
the  career  of  lead  workers,  nor  is  there  any  pro- 
nounced persistency.  A  workman  whose  blood 
pressure  was  138  millimetres  Hg,  and  next  week 
130,  may  in  the  following  week  have  a  still  lower 
pressure,  or  it  may  be  higher.  The  average  blood 
pressure  of  the  eighty-four  male  lead  workers 
referred  to  above  was  122*3  ;  the  highest  recorded 


BLOOD  PRESSURE  AND  WORKING  IN  LEAD    191 

was  138,  and  the  lowest  100.  One  of  the  men 
had  a  blood  pressure  of  169,  but  his  urine  con- 
tained albumin,  and  he  seemed  to  be  the  subject 
of  granular  kidney,  a  circumstance  which  in  him 
and  two  other  workmen  raised  the  question 
whether  the  high  arterial  tension  was  the  conse- 
quence of  the  action  of  lead  qua  lead  upon  the 
bloodvessels,  or  of  the  poisonous  products  formed 
in  the  body  as  the  result  of  the  action  of  lead  upon 
such  of  the  internal  organs  as  the  liver  and 
kidneys. 

In  the  series  of  blood-pressure  experiments  made 
by  Professor  Bolam  and  myself,  and  to  which 
attention  has  been  drawn,  death  came,  as  can  be 
seen  from  the  charts,  through  a  fall  of  blood 
pressure,  owing  to  the  effect  of  lead  upon  the 
heart.  These  experiments  show  how  minute 
quantities  of  lead  can  adversely  affect  the  heart 
and  circulation.  The  average  blood  pressure  of 
another  series  of  men  working  in  white  lead  in  New- 
castle-upon-Tyne was  131  "4,  and  the  highest  180. 
It  seems  to  me  that  during  the  early  years  of 
employment  in  a  lead  factory  the  work  does  not 
affect  to  any  marked  degree  the  blood  pressure, 
but  there  is  hardly  any  doubt  that  as  time  goes 
on  and  the  function  of  the  eliminating  organs  is 
interfered  with,  the  blood  pressure  rises,  also  that 
structural  changes  are  induced  in  the  arteries,  for 


192  LEAD  POISONING 

/only  by  this  means  can  be  explained  the  large 
number  of  deaths  from  cerebral  haemorrhage  in 
persons  who  have  worked  in  lead.  The  duration 
of  the  employment  and  of  the  particular  kind  of 
work  the  men  follow  in  the  factory,  their  home 
life  and  habits,  must  materially  influence  this 
question  of  blood  pressure. 

Chemical  Examination  of  the  Urine  and  of 
the  Organs  of  the  Body  for  Lead. 

In  testing  for  lead  in  urine  Professor  Bedson, 
Armstrong  College,  Newcastle-upon-Tyne,  makes 
use  of  the  following  method  :  50  cubic  centimetres 
of  urine  are  placed  in  a  shallow  porcelain  basin 
and  evaporated  practically  to  dryness  on  a  water- 
bath  ;  it  is  carbonized  in  a  muffle  furnace ;  the 
residue  is  moistened  with  strong  nitric  acid,  and 
ignited  gently.  The  residue  is  perfectly  white. 
This  is  moistened  with  strong  hydrochloric  acid 
and  evaporated  to  dryness.  It  is  ignited  gently  on 
a  muffle  and  cooled ;  a  few  drops  of  hydrochloric 
acid  are  added,  and  then  water  ;  it  is  allowed  to 
stand  for  a  few  minutes,  after  which  it  is  poured 
into  a  Nessler  glass.  The  solution  is  made  just 
alkaline  with  a  few  drops  of  ammonia,  then 
slightly  acid  with  a  few  drops  of  hydrochloric  acid. 
If  necessary  it  is  filtered,  and  the  amount  made  up 
to  50  cubic  centimetres.    To  this  are  added  2  cubic 


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WATER  CONTAMINATED  BY  LEAD         193 

centimetres  of  freshly  prepared  sulphuretted 
hydrogen.  A  dark  coloration  indicates  lead  i  all 
other  metals  being  known  to  be  absent).  The 
estimation  of  the  amount  of  lead  is  effected  by  a 
comparison  of  the  coloration  produced  under  like 
conditions  with  a  standard  lead  solution. 

Several  methods  of  detecting  lead  in  urine  and 
organic  compounds  are  described  in  the  textbooks 
— also  of  detecting  lead  in  the  organs  after  death. 
As  the  methods  are  complex  and  require  con- 
siderable knowledge  of  analytical  chemistry,  I 
prefer  to  have  all  these  examinations  carried  out 
for  me  by  competent  chemists,  and  in  view  of 
the  questions  which  might  be  raised  in  cases  con- 
nected with  the  Workmen's  Compensation  Act,  I 
would  advise  medical  practitioners  to  refer  such 
examinations  to  analytical  chemists  whose  skill  and 
verity  are  beyond  question. 

Anomalous  Symptoms  due  to  Drinking  Water 

Contaminated  by  Lead. 

I  have  not  the  slightest  doubt  that  there  are 
many  cases  of  illness  attended  by  obscure  nervous 
symptoms  of  which  no  explanation  can  be  given, 
and  which  are  illustrations  of  atypical  plumbism. 
Patients  thus  suffering  are  seen  and  treated  by 
medical  men  without  the  true  nature  of  their 
malady  being  recognized.     This  is  likely  to  occur 

11 


V 


i94  LEAD  POISONING 

when  there  is  no  history  of  exposure  to  lead 
offered  by  the  patient  or  elucidated  by  the 
physician.  Where  the  teeth  are  kept  clean  by 
brushing,  and  there  is  no  blue  line  on  the  gums, 
one  important  sign,  at  least,  of  plumbism  is  want- 
ing ;  and  where  colic  has  never  been  so  severe  or 
recurrent  as  to  have  impressed  itself  upon  a 
patient,  another  recognized  symptom  of  plumbism 
is  absent.  An  increase  in  the  number  of  mis- 
carriages or  of  stillbirths  in  a  town  or  district 
should  cause  medical  men  to  suspect  lead  either 
in  the  drinking-water  or  in  drugs  taken  sur- 
reptitiously. If  neuralgia  be  set  aside,  severe 
headache  in  the  absence  of  signs  of  cerebral 
tumour,  organic  disease  of  the  brain,  and  the 
possibility  of  structural  defects  of  the  eyes  may,  if 
attended  by  anaemia  or  cachexia,  be  reasonably 
regarded  as  toxaemic.  The  phenomena  to  which 
I  want  specially  to  draw  attention  as  suggesting 
plumbism  are  a  gradual  enfeeblement  of  the 
physical  and  mental  powers  with  loss  of  weight, 
impaired  locomotion,  also  a  train  of  nervous 
symptoms,  of  which  sleeplessness,  intense  depres- 
sion of  spirits,  forgetfulness,  inability  to  apply 
oneself  to  mental  work,  with  at  times  symptoms 
simulating  hysteria  or  general  paralysis  are  the 
most  prominent.  These  symptoms  in  the  absence 
of  a  blue  line  on  the  gums  or  of  a  history  of  colic 


WATER  CONTAMINATED  BY  LEAD         195 

are  frequently  due  to  plumbism,  as  shown  by  a 
chemical  examination  of  the  urine.  Owning  such 
a  cause,  the  symptoms  are  exhibited  by  persons 
under  unexpected  circumstances,  both  as  regards 
place  and  social  position,  that  it  is  no  surprise 
medical  men  are  thrown  off  their  guard.  In  many 
of  the  cases  there  is  no  basophilia,  but  lead  is 
found  in  the  urine  during  life,  and  in  the  internal 
organs  after  death.  In  many  of  the  cases  the 
cause  of  the  illness  has  been  the  domestic  use  of 
drinking-water  possessing  high  plumbo- solvent 
powers.  Given  an  affected  area,  the  consequences 
may  be  far-reaching,  as  the  sequel  shows.  Some 
months  ago  I  was  asked  by  a  medical  friend  to 
see  in  consultation  with  him  a  series  of  cases 
which,  notwithstanding  their  atypical  character, 
were  undoubtedly  plumbism.  One  of  the  patients, 
a  young  married  woman,  had  recently  been  con- 
fined. During  the  course  of  her  convalescence, 
and  when,  from  an  obstetrical  point  of  view,  there 
was  nothing  to  cause  acute  abdominal  pain,  she 
became  the  subject  of  severe  headache.  Her 
infant,  although  at  the  breast,  was  losing  flesh 
instead  of  gaining  it,  was  constantly  crying  and 
pulling  up  his  legs  as  if  in  pain.  Some  of  the 
mother's  milk  was  sent  to  me  for  analysis,  and  in 
it  Professor  Bedson  found  0*4  part  of  lead  per 
million  ;  he  also  found  lead  in  the  mother's  urine. 


i96  LEAD  POISONING 

Breast-feeding  was  discontinued,  and  from  that 
moment  the  infant  ceased  to  have  pain  and  began 
to  increase  in  weight.  Had  I  not  known  of  the 
endemic  plumbism,  a  true  diagnosis  of  the  infant's 
condition  might  not  have  been  made.  The  child 
might  have  gone  on  suffering,  and  probably  would 
have  died.  Under  treatment  the  mother  also 
made  a  satisfactory  recovery. 


What  Constitutes  Lead  Poisoning  ? 

The  Workmen's  Compensation  Act,  and  the 
claims  by  working  men  arising  out  of  it  have  im- 
posed duties  upon  medical  practitioners  not  always 
easily  discharged.  The  diagnosis  of  lead  poisoning 
may  be  easy  or  it  may  be  difficult.  In  Great 
Britain  law  has  decided  that  certain  diseases  of 
occupation  which  have  been  scheduled  shall  be 
considered  as  accidents  from  a  compensation 
point  of  view.  When  men  and  women  who  have 
been  working  in  lead  become  ill  they  are  naturally 
disposed  to  regard  the  illness  as  in  some  way 
or  other  dependent  upon  their  occupation.  The 
burden  of  proof  that  they  are  suffering  from  lead 
poisoning  is  thrown  upon  the  workpeople.  Should 
the  claim  be  substantiated,  the  employer  in  whose 
service  the  previous  twelve  months  were  spent  is 
liable  for  compensation.  Since,  however,  plumb- 
ism is  of  gradual  development,  and  a  workman  may 


WHAT  CONSTITUTES  LEAD  POISONING?    197 

have  been  employed  in  more  than  one  lead  factory 
during  the  previous  twelve  months,  the  liability  is 
divided  amongst  the  various  employers.  Given  a 
history  of  work  in  lead,  the  presence  of  a  blue  line 
on  the  gums,  history  of  colic,  presence  of  anaemia, 
basophilia,  double  wrist-drop,  and  the  detection  of 
lead  in  the  urine,  there  is  no  difficulty  in  diagnosing 
the  malady  as  plumbism.  The  difficulty  arises 
when  most  of  the  usual  signs  and  symptoms  of 
lead  poisoning  are  absent.  It  is  generally 
admitted  that  the  presence  of  a  blue  line  on  the 
gums  is  no  proof  that  the  individual  is  suffering 
from  plumbism.  It  is  only  a  sign  that  there  is 
lead  in  the  system,  or  that  the  individual  has  been 
brought  into  contact  with  lead.  On  the  other 
hand,  the  Burtonian  jine,  when  accompanied  by  \y/ 
other  signs  and  symptoms,  is  most  valuable  so 
long  as  such  a  possible  cause  as  bismuth,  for  L^ 
example,  can  be  excluded.  Some  physicians  find 
in  basophilia  a  reliable  test  of  plumbism.  When 
present  it  is  of  assistance. 

I  have  not  found  basophilia  the  help  it  has  been 
to  other  physicians.  Personally,  I  rely  more  upon 
the  detection  of  lead  in  the  urine.  Its  presence 
therein  is  an  indication  that  the  metal  is  in  the 
system,  and  is  being  eliminated.  On  the  other 
hand,  lead  may  be  found  in  the  urine  of  lead 
workers   without    the    men    betraying   plumbism. 


198  LEAD  POISONING 

These  men,  however,  are  on  the  border-line.  Let 
elimination  be  checked,  and  symptoms  at  any 
,/time  may  arise.  The  presence  of  lead  in  the  urine 
occupies  the  same  relationship  to  saturnism  as 
Koch's  bacillus  does  to  tuberculosis,  Eberth's 
bacillus  to  typhoid  fever,  and  Klebs  -  Loffler 
bacillus  to  diphtheria.  Men  and  women  may  be 
typhoid  carriers,  they  may  be  distributing  the 
germs  everywhere,  and  spreading  typhoid  fever, 
while  they  themselves  are  not  suffering  from  the 
disease.  What  then  are  they  suffering  from  ? 
With  the  word  "  suffering  "  we  have  come  to 
associate  too  much  the  idea  of  pain,  a  sense  of 
annoyance,  or  a  feeling  of  discomfort,  whereas 
it  only  means  bearing  or  sustaining.  A  man  who 
is  unaccustomed  to  stimulants,  and  who  has 
exceeded  the  limits  of  moderation  on  a  particular 
occasion,  is  the  subject  of,  or  is  said  to  be 
temporarily  suffering  from,  alcoholic  intoxication  ; 
but  the  man  who  keeps  nipping  all  day  long,  and 
who  is  never  drunk,  may  show  fewer  signs  of  intoxi- 
cation, although  of  the  two  men  he  is  the  greater 
alcoholic,  and  the  less  likely  to  be  brought  back 
within  the  range  of  the  normal.  In  a  similar 
manner  a  man  may  have  a  blue  line  on  his  gums, 
and  lead  be  present  in  the  urine,  without  such  a 
person  suffering  from  plumbism.  The  child  of  a 
female  lead  worker  dies  shortly  after  birth,  and  in 


WHAT  CONSTITUTES  LEAD  POISONING?    199 

the  internal  organs  lead  is  found.     The   mother 
had  never  been  off  ill,  and  yet    her   infant    dies 
from  the  effects  of  plumbism,  due  to  lead  conveyed 
from  the  maternal  blood.     She  is  a  lead  carrier. 
There  is  the  death  from  plumbism  without  the 
mother  having  exhibited  symptoms,  and  yet  she 
was  not  free  from  lead  or  the  possible  presentation 
of  symptoms  from  it,  for  it  occasionally  happens 
that  after  a  confinement  such  a  mother  becomes 
paralyzed  in  her  arms,  a  condition  which,  setting 
aside    possible    obstetrical    causes,    is    rightly    or 
wrongly  regarded  as  due  to  lead.   When,  we  ask,  did 
such  a  patient  become  lead-poisoned  ?    Was  it  only 
when  she  developed  paralysis  ?    Or  was  she  not  pas- 
sively lead-poisoned  all  the  time?     In  this  problem 
of  lead  poisoning  it  seems  to  me  that  we  must  get 
rid  of  complaints,  and  the  expression  of  suffering 
immediately  relative  to  lead,  and   deal  with  the 
effects  of  the  metal  generally.  As  in  chronic  alcohol- 
ism, so  in  plumbism  the  old  lead  worker  who  has 
never  been  off  ill,  who  breaks  down  in  health  or 
dies  without  having  shown  the  ordinary  signs  and 
symptoms  of  plumbism,  is  not  less  the  victim  of 
the  malady  and  entitled  to  compensation  than  the 
man  or  woman  who,  a  few  months  after  taking  up 
the  work,  has  developed  colic  or  wrist-drop.     In  a 
sense  he  is  more  entitled  to  compensation,  for  by 
his  long  term  of  service  he  has  contributed  more 


200  LEAD  POISONING 

to  the  trade,  and  has  cost  his  employer  less  than 
those  men  or  women  who  have  broken  down  in 
health  in  the  earlier  stages  of  their  working  career. 
*    There  is  another  question.     It  is  not  only  that 
patients  presenting  obscure  symptoms  must  have 
their  symptoms  carefully  scrutinized,  but  also  the 
complaints  of  those  who  consult  medical  men  for 
the   side   issues   of  plumbism.     A    painter   seeks 
medical  advice  for  gout.     This  disease  is  known 
to  be  an   indirect  result  of  lead.     It  is  also  and 
much  more  frequently  the  result  of  constitutional 
causes  and  conditions  in  no  way  associated  with 
lead.     But  for  having  worked  in  lead  the  proba- 
bility is  that  the  painter  would  not  have  had  gout. 
Is  such  a  patient  entitled  to  compensation  ?     Or 
take  another  illustration :  contracted  kidney  is  a 
recognized  consequence  of  long  exposure  to  lead. 
This  form  of  Bright's  disease  might  develop  in  a 
plumber,  for  example,  just  as  in  any  other  person, 
and  be  in  no  way  connected  with  lead,  but  because 
it  is  a  more  frequent  cause  of  death  in  persons 
exposed  to  lead  than  in  other  persons,  saturnine 
nephritis  has  ccme  to  be  recognized  in  a  court  of 
law  as  a  disease  of  occupation,  and  compensation 
has  been  given  to  the  relatives.    Particularly  is  this 
so,  when  on  chemical  analysis  lead  has  been  found 
in  the  internal  organs.     On  the  other  hand,  the 
absence  of  lead  in  the  internal  organs  does  not 


WHAT  CONSTITUTES  LEAD  POISONING?    201 

prove  that  the  case  was  not  lead  poisoning.  In  one 
of  my  own  patients  who  died  from  acute  saturnine 
encephalopathy  no  lead  was  found  in  the  brain, 
and  yet  there  was  no  doubt  as  to  death  having  been 
caused  by  exposure  to  lead.  Under  any  circum- 
stances it  is  only  a  minute  quantity  of  lead  which 
is  present  in  the  body,  and  a  more  minute  quantity 
still  which  is  circulating  in  the  blood  and  causing 
harm.  It  is  impossible  to  give  such  a  compre- 
hensive definition  of  plumbism  as  will  include 
all  cases.  In  industrial  plumbism  two  types  of 
the  malady  are  met  with — active  and  latent.  It  is 
in  latent  plumbism  that  the  difficulty  of  diagnosis 
arises,  for  a  man  who  is  passing  lead  in  his  urine 
may  not  be  suffering  at  the  time  from  plumbism, 
and  yet  at  any  moment  active  manifestations  of  the 
disease  may  show  themselves  even  months  after  the 
individual  has  retired  from  the  factory. 

Treatment  :  Preventive. 

The  treatment  of  lead  poisoning  is  preventive 
and  curative.  In  making  a  tour  of  inspection  of  a 
white  or  a  red  lead  factory,  the  workmen  in  some 
of  the  departments  are  observed  to  be  paler  than 
men  employed  in  other  occupations.  Although 
they  are  pale  and  unhealthy-looking,  and  although 
also  on  their  gums  a  delicate  blue  line  is  observed, 


202  LEAD  POISONING 

these  men  are  not  suffering  from  plumbism.  They 
are  all  able  to  follow  their  employment,  for  the 
bulk  of  the  lead  which  is  being  taken  into  the 
system  is  not  all  being  retained  :  elimination  keeps 
pace  with  absorption.  In  the  case  of  several  of 
the  workers  it  is  a  slender  line  which  separates 
lead  absorption  from  lead  intoxication.  A  work- 
man who  has  been  for  years  daily  absorbing  and 
eliminating  lead,  who  has  been  becoming  paler 
and  paler,  is  occupying  a  delicate  position.  A 
slight  check  to  the  activity  of  his  emunctory 
organs,  and  what  was  until  then  a  pre-saturnine 
condition — that  is,  a  condition  preparatory  to,  but 
not  actually  one  of,  saturnism — becomes  gradually 
one  of  lead  poisoning.  It  would  be  a  prudent  act 
on  the  part  of  factory  surgeons  and  employers  to 
give  workmen  who,  judging  from  pre-saturnine 
cachexia,  are  thus  brought  to  the  verge  of  breaking 
down  in  health,  a  holiday  for  a  fortnight  two  or 
three  times  a  year,  so  that  absorption  of  lead 
might  be  interrupted,  and  elimination  promoted. 
The  good  effects  of  absence  from  work  and  rest 
are  in  some  persons  rapidly  apparent.  In  lead 
factories  where  the  economic  conditions  do  not 
permit  of  the  hands  being  given  temporary  respite 
from  work,  there  should  be  alternation  of  employ- 
ment. It  is  a  mistake  to  keep  workmen  always  in  the 
white  or  red  lead  processes  ;  they  should  from  time 


TREATMENT :  PREVENTIVE  203 

to  time  be  transferred  to  the  yard  or  given  some 
outdoor  kind  of  employment. 

The  British  Home  Office  regulations  compare 
most  favourably  with  those  of  other  countries,  and 
on  the  whole  they  are  attended  to.  As  regards 
personal  hygiene  the  workers  are  not  always  as 
true  to  themselves  as  they  ought  to  be.  The  lead 
industry  is  considerably  improved  to  what  it  was 
years  ago,  and  there  is  an  increasing  desire  on  the 
part  of  most  manufacturers  to  do  all  they  reason- 
ably can  to  render  the  trade  as  free  from  risk  to 
health  as  possible.  The  abolition  of  female  1/ 
labour,  and  the  substitution  for  it  of  male  labour 
in  dangerous  processes,  although  resented  at  the 
time  by  some  employers  on  the  ground  of  derange- 
ment of  work,  difficulty  of  finding  male  labour,  and 
expense,  is  now  generally  admitted  to  have  been  a 
step  in  the  right  direction.  It  has  purified  the 
industry,  and  averted  suffering.  Attention  to 
details  of  personal  cleanliness,  the  work  of  the  day 
never  begun  without  food  having  been  taken, 
provision  of  ample  washing  and  bathing  facilities 
by  owners,  wearing  of  overalls  by  employees, 
change  of  clothing  and  of  boots  when  work  is 
finished,  no  eating  when  at  work,  nor  until  after 
washing,  no  chev/ing  of  tobacco,  or  of  smoking  when  y 
at  work,  are  regulations  which  are  productive  of 
good. 


204  LEAD  POISONING 

L--^"Periodical  but  frequent  medical  examination  of 
the  workers,  once  a  week  of  persons  employed  in 
dangerous  processes,  with  power  to  suspend,  has 
also  been  of  signal  service  in  reducing  the  number 
of  cases  of  plumbism.  It  would  pay  employers  to 
set  aside  a  good  room  in  the  factory  for  the 
medical  examination  of  the  workers.  The  room 
should  be  bright  and  with  plenty  of  daylight  ad- 
mitted by  a  window  in  the  roof.  Since  dust  is  the 
enemy  of  the  worker,  all  efforts  must  be  made  to 
render  the  workrooms  as  free  from  dust  as  possible, 
either  by  improving  methods  of  manufacture, 
whereby  little  or  no  dust  is  generated,  by  preventing 
its  escape  into  the  workroom,  or  its  removal  there- 
from by  means  of  fans.  Fumes  should  be  simi- 
K  larly  dealt  with.  Hearty  co-operation  of  employer 
and  employed  in  regard  to  regulations  is  a  neces- 
sity. In  the  arts  and  sciences  lead  cannot  be 
readily  dispensed  with.  Where  possible  it  is 
desirable,  from  a  health  point  of  view,  that  a 
substitute  should  be  found  for  lead.  It  is,  how- 
ever, not  total  abolition  of  lead  that  is  called  for 
so  much  as  more  hygienic  methods  of  its  manu- 
facture, always  remembering  that  lead  compounds, 
wherever  and  whenever  handled  or  operated  upon, 
are  products  of  a  distinctly  poisonous  character. 
The  prevention  of  plumbism  should  begin  not 
after  the  men  have  entered  a  factory,  but  before 


TREATMENT :  PREVENTIVE  205 

they  commence  work  in  it.  A  cursory  medical 
examination  of  applicants  for  work  is  not  enough. 
It  must  be  thorough. 

At  one  of  the  large  lead  factories  in  Newcastle- 
upon-Tyne  Dr.  Irvine  has  instituted  a  procedure 
to  which  I  have  already  drawn  attention.  It  is 
well  worthy  of  being  adopted  elsewhere.  Any 
person  applying  for  work  is  not  only  questioned  as 
to  his  health  and  previous  occupation,  but  his 
mouth  and  teeth  are  examined,  and  their  con- 
dition noted;  the  urine  is  tested  for  albumin; 
a  sphygmogram  is  taken,  also  a  blood-pressure 
record.  If,  on  applying  for  work,  a  man  has  a 
blood  pressure  of  140  millimetres  Hg,  such  an 
applicant  is  refused.  By  these  means  Dr.  Irvine 
has  kept  the  works  practically  free  from  plumbism. 
By  the  substitution  of  mechanical  and  automatic 
methods  for  hand  labour  in  the  transference  of 
raw  white  lead  and  the  packing  of  finished  lead 
products  much  has  been  gained  from  a  health 
point  of  view,  while  in  the  manufacture  of  red 
lead,  the  introduction  of  minus  pressure  methods 
whereby  air  is  drawn  into  the  closed  machinery 
rather  than  expelled  from  it,  also  the  grinding 
and  mixing  of  colours  in  closed  machinery,  have 
rendered  the  atmosphere  of  lead  factories  com- 
paratively free  from  dust.  In  white  lead  factories 
the  substitution  of  mechanical  methods  of  filling 


206  LEAD  POISONING 

and  emptying  the  drying-stoves,  the  use  of  closed 
drying-ovens  with  inside  peripheral  canals  into 
which  the  dried  lead  carbonate  can  be  raked,  have 
robbed  drying  of  much  of  its  dangers.  In  some 
white  lead  factories  ovens  or  stoves  have  been 
dispensed  with  altogether.  In  making  white  lead 
paint  it  is  not  necessary  to  dry  the  lead  first.  The 
pigment  removed  from  the  white  beds  can  be 
passed  through  crushers  and  washed,  and  after- 
wards passed  on  through  a  series  of  rollers  between 
which  the  pulp  comes  into  contact  with  oil.  The 
water  is  gradually  displaced  by  the  oil,  with  the 
result  that,  practically  speaking,  a  finished  white 
lead  paint  containing  only  a  mere  trace  of  water 
escapes  from  the  last  cylinder.  This  method  of 
directly  treating  the  white  lead  obviates  the 
necessity  of  handling  the  product  and  of  drying  it. 
In  all  dusty  processes  the  shifts  should  not  be  too 
long,  for  if  men  are  wearing  respirators,  and  the 
work  is  hard,  breathing  becomes  difficult,  and  the 
men  become  overheated.  In  cleaning  out  the 
Hues  of  a  lead-smelting  factory,  the  men  should 
not  work  longer  than  two  hours  at  a  stretch  with- 
out having  an  hour's  rest.  A  workman  suspended 
on  account  of  illness  or  indisposition  should  not,  if 
he  has  been  absent  over  a  fortnight,  be  allowed  to 
resume  work  in  a  lead  factory  without  undergoing 
a  medical  examination  as  to  the  state  of  his  health 


TREATMENT :  PREVENTIVE  207 

and  physical  fitness.  Since  some  persons  are 
more  susceptible  to  lead  than  others,  any  indica- 
tion of  impending  impairment  of  health  should 
become  cause  for  the  medical  examiner  and 
employer  removing  a  worker  at  once  to  outside 
labour.  Since  poverty  and  general  deprivation 
predispose  to  plumbism,  it  is  safer  to  draw  work- 
men from  the  class  above  the  abjectly  poor.  No 
person  addicted  to  alcohol  should  be  employed  in 
lead.  At  the  close  of  each  shift  the  men  before 
leaving  the  factory  should  carefully  wash  their 
hands  and  forearms,  brush  their  nails,  gargle  the 
throat,  and  douche  the  nostrils  with  mild  saline 
solution.  At  one  large  factory  on  Tyneside  the 
men  are  given  daily  small  chocolate  -  coated 
tabloids  containing  sulphide  of  soda.  It  is 
claimed  that  these  possess  a  distinctly  preventive 
influence  against  plumbism.  Workers  in  lead 
should  see  to  it  that  they  do  not  suffer  from  con- 
stipation. 

All  lead  factories  should  be  so  situated  that 
the  various  workplaces  can  be  freely  flushed  with 
currents  of  air.  Plans  for  new  lead  factories  should 
be  submitted  to  the  Home  Office  for  confirmation 
and  suggestion.  For  the  maintenance  of  hygienic 
conditions  inside  a  factory,  several  dust-collecting 
systems  are  in  use  to  collect  lead  escaping  into  the 
air.    Care  must  be  taken  to  see  that  these  exhaust 


208  LEAD  POISONING 

pipes  are  kept  clear,  otherwise  they  get  choked 
with  dust,  and  become  worse  than  useless.  The 
cleaning  of  machinery,  also  the  cleaning  and  chip- 
ping of  the  stones  used  for  grinding  and  mixing 
white  lead,  are  attended  with  danger.  Every 
hopper  and  machine  containing  lead  in  the  form 
of  dust  should  be  provided  with  a  dust-exhaust. 
All  melting-pots  should  be  hooded.  By  ventilation 
and  provision  of  exhausts  wherever  possible, 
respirators  may  be  dispensed  with.  During 
structural  alterations  in  lead  factories  the  greatest 
care  should  be  exercised,  and  all  workmen, 
whether  they  belong  to  the  factory  or  not,  should 
be  apprised  of  the  dangers  they  may  be  exposed  to, 
as  the  following  case  shows :  A  few  years  ago  it 
was  found  necessary  to  enlarge  the  capacity  of  the 
plant  in  a  white  lead  factory  without  stopping  the 
manufacture.  Large  numbers  of  men  were  em- 
ployed, and  a  foreman  was  appointed  to  super- 
intend the  work,  so  far  as  concerned  keeping  the 
labourers  right  in  matters  of  cleanliness  and  the 
wearing  of  respirators.  How  signally  this  man 
failed  in  his  duty  the  sequel  shows.  Not  only  did 
he  himself  become  lead-poisoned,  but  within  a 
space  of  two  months  there  were  forty  cases  of  lead 
poisoning  in  the  factory  ;  two  of  the  men  died,  two 
were  paralyzed  in  hands  and  feet;  in  the  remainder 
the  symptoms  were  of  a  slighter  character,  so  that 


TREATMENT :  PREVENTIVE  209 

they  soon  recovered.  Most  of  the  men  who  became 
poisoned  were  working  on  construction.  By  dis- 
charging all  the  intemperate  men,  hiring  a  special 
foreman  and  placing  him  in  charge  of  the  bath- 
rooms, with  instructions  to  report  and  cause  to  be 
discharged  any  man  seen  leaving  the  premises  or 
eating  without  thoroughly  washing  himself  and 
changing  his  clothes,  by  appointing  a  doctor  to  the 
works,  and  having  a  weekly  medical  examination, 
the  results  were  highly  satisfactory.  No  serious 
case  of  lead  poisoning  has  occurred  since  then. 

To  prevent  endemic  plumbism  caused  by  drink- 
ing-water gathered  on  peaty  soils,  water  companies  v 
should  have  the  deliveries  tested  lor  plumbo- 
solvency  two  or  three  times  a  year,  so  that  proper 
amounts  of  chalk,  limestone,  or  other  correctives 
may  be  added  ;  and  to  render  water  free  from  lead 
in  the  household  supply  the  water  should  be 
passed  through  filters  made  from  animal  charcoal 
rich  in  phosphate. 

Treatment:  Curative. 

As  anaemia   is   an    early  sign  of  plumbism,   a 
workman  suspended  from  the  factory  should  be 
encouraged  to  spend  most  of  his  time  in  the  open      \j 
air.     He  should  be  given  a  mild  iron  tonic,  with 
or    without    magnesium    sulphate.     If    colic    is 

14 


210  LEAD  POISONING 

moderately  severe  it  should  be  treated  by  applica- 
tion of  warmth  to  the  abdomen,  or  by  a  warm 
bath,  and  if  there  is  sickness  an  effervescing  soda 
and  bismuth  mixture  containing  a  few  drops  of 
nepenthe  should  be  given    When  there  is  obstinate 

I  constipation    in    addition  to    colic,    castor   oil   is 

(     called  for.     Croton    oil  in  i-drop  doses  may  be 

administered    if    constipation    is    extreme,     but 

i  ounce  of  olive  oil  in  warm  milk  taken  by  the 

/  mouth,  or  a  rectal  enema  of  olive  oil  and  warm 
water  should  be  tried  first.  In  some  cases  the 
abdominal  pain  is  so  severe  as  to  call  for  the 
administration  of  morphia  hypodermically.  Even 
when  the  bowels  have  been  freely  opened  by 
aperients  the  abdominal  pain  may  continue  for  a 
few  days.  This  type  of  pain  is  aggravated  by 
pressure.  It  can  be  relieved  by  administering 
sodium  monosulphite  in  §  or  i  grain  doses  three 
or  four  times  a  day.  On  the  recommendation  of 
Dr.  Stevens  of  Cardiff  I  have  given  with  great 
relief  to  patients  suffering  from  lead  colic  perman- 
ganate of  calcium  in  ^-grain  doses  thrice  daily. 

For  colic  a  mixture  of  potassium  iodide  and 
magnesium  sulphate  is  sometimes  ordered.  This 
should  not  be  adopted  as  a  routine  treatment,  for 
potassium  iodide  has  the  power  of  dissolving  lead 
which  has  been  lying  inert  and  stored  in  the 
tissues,  of  causing  it  to  circulate  in  the  blood  and 


TREATMENT :  CURATIVE  211 

thereby  of  intensifying  the  saturnine  intoxication. 
As  regards  the  treatment  of  wrist-drop,  some 
patients  find  relief  by  resting  the  hand  on  a  splint 
and  carrying  it  in  a  sling.  Massage  and  electricity 
give  good  results,  either  alone  or  combined 
with  the  internal  administration  of  2  or  3  minims 
of  liquor  strychniae,  or  5  minims  or  more  of  tincture 
of  nux  vomica.  To  the  nux  vomica  mixture  a  few 
grains  of  iodide  of  potassium  may  be  added.  For 
epileptiform  convulsions  large  doses  of  the  bromides 
may  be  given  by  the  mouth  or  by  the  rectum  ; 
nitrite  of  amyl  may  be  inhaled,  or  lumbar  puncture 
performed.  An  enema  of  mustard  and  warm 
water  may  be  administered  if,  in  addition  to  con- 
vulsions, there  is  constipation. 

For  chronic  plumbism  where  there  are  anaemia, 
albuminuria,  and  such  symptoms  suggestive  of 
interstitial  nephritis  as  headache,  imperfect  vision, 
swollen  features,  and  oedema  of  the  feet,  also 
emaciation,  the  medical  treatment  resolves  itself 
into  ordinary  care  of  the  patient  and  treatment  of 
his  symptoms  generally.  Opinions  are  divided  as 
to  whether,  when  a  doctor  detects  albumin  in 
the  urine  of  an  old  lead  worker  in  whom  there 
is  no  doubt  as  to  the  existence  of  interstitial 
nephritis,  such  an  individual  should  be  compulsorily 
obliged  to  retire  from  work  in  the  lead  factory. 
Experience  shows  that  men  can  go  on  working 


212  LEAD  POISONING 

in  a  lead  factory  for  years,  and  enjoy  fairly 
good  health,  even  though  they  are  the  subjects 
of  chronic  kidney  disease,  and  experience  equally 
shows  when  such  men  have  been  obliged  to  with- 
draw from  the  factory,  that,  owing  to  their 
diminished  weekly  income,  as  they  are  unable  to 
obtain  proper  food,  they  worry  and  become  ill. 
The  detection  of  albumin  in  the  urine  of  a  com- 
paratively young  lead  worker  is  another  thing 
altogether.     He  ought  to  give  up  work  in  lead. 

As  a  supplement  to  the  preventive  and  curative 
treatment  of  plumbism,  I  should  like  to  draw 
attention  to  another  line  of  treatment  with  which 
the  names  of  Mr.  T.  M.  Clague,  of  Newcastle- 
upon-Tyne,  and  myself  are  associated.  It  is  the 
double  electrical  bath  treatment.  Dr.  Lewis 
Jones  was  kind  enough  a  few  years  ago  to 
contribute  to  my  book,  "  Dangerous  Trades,"  an 
article  on  the  electrical  treatment  of  plumbism. 
He  showed  how,  under  the  single  bath  electrical 
treatment,  patients,  when  paralyzed,  made  a 
quicker  recovery  than  without  it.  Massage  and 
medicinal  treatment  were  by  it  rendered  more 
effective.  Patients  who  are  the  subjects  of  lead 
.poisoning  keep  eliminating  lead  by  the  kidneys 
and  by  the  bowels.  Electrolysis  causes  lead  to 
pass  by  a  process  akin  to  osmosis  from  the  body 
to  the  electrodes  in  the  bath  in  which  the  patient 


TREATMENT :  CURATIVE  213 

is  immersed.  The  experimental  evidence  that 
lead  can  be  extracted  from  the  body  of  man  by 
electrolysis  is  not  free  from  sources  of  error,  for 
the  amount  of  the  metal  in  the  body  at  any  time 
must  be  small,  probably  not  more  than  a  few 
grains,  so  that  there  would  be  in  a  dipolar  bath — 
that  is,  a  bath  into  which  both  poles  are  placed 
— considerable  difficulty  in  finding  measurable 
quantities  of  lead  deposited  on  the  electrodes  in 
the  bath.  In  the  single  bath  the  lead  deposited 
on  the  positive  pole  appears  as  peroxide,  and  on 
the  negative  pole  it  is  found,  according  to  Dr.  Lewis 
Jones,  in  a  spongy  metallic  form.  There  is 
always  the  possibility  of  lead  found  in  the  bath- 
water having  come  from  the  skin  of  the  workman. 
For  example,  it  might  be  lead  which  had  simply 
been  lying  on  the  surface  of  the  body,  or  lead  in 
the  process  of  elimination  by  the  glands  of  the 
skin,  but  admitting  these  as  possible  sources  of 
the  metal,  there  is  not  the  least  doubt  that 
electrolysis  favours  the  elimination  of  lead  from 
the  body  by  the  skin. 

In  a  paper*  published  a  few  months  ago,  I  drew 
attention  to  the  use  of  the  double  electrical  bath 
which  had  been  suggested  to  me  by  Mr.  T.  M. 
Clague,  to  whom  I  had  applied  for  assistance 
as   to   the   possibility   of  removing   lead    from   a 

*  Lancet,  August  23,  1913. 


214  LEAD  POISONING 

rabbit  the  subject  of  experimental  lead  poisoning. 
During  the  three  years  the  animal  was  under  ob- 
servation he  had  received  1,096  grains  of  nitrate 
of  lead,  the  equivalent  of  684  grains  of  metallic 
lead.  After  having  taken  a  few  hundred  grains 
of  nitrate  of  lead,  the  animal  became  painlessly 
paralyzed.  It  was  then  that  I  asked  whether, 
by  means  of  electrolysis,  lead  could  not  be 
removed  from  the  body  of  the  animal,  and  the 
opportunity  given  to  him  of  regaining  health.  As 
a  result  of  the  double  electrical  bath  the  paralysis 
quickly  disappeared,  and  the  animal  made  a  good 
recovery.  The  fore-limbs  of  the  animal  were 
placed  in  one  bath  along  with  the  negative  pole, 
and  the  hind-limbs  in  another  bath  with  the 
positive  pole,  the  chest  and  abdomen  of  the 
animal  resting  on  a  soft  cushion  of  cotton  wadding. 
After  a  bath  of  an  hour's  duration  lead  was  found 
on  the  negative  electrode,  and  in  the  bath-water. 
Several  weeks  after  the  rabbit  had  regained  its 
health  and  vigour,  small  doses  of  lead  were  again 
administered,  with  the  result  that  the  animal  for 
a  second  time  became  paralyzed.  Treated  by 
the  double  electrical  bath,  the  paralysis  dis- 
appeared, and  the  rabbit  was  soon  in  the  vigour  of 
health  once  more.  After  a  respite  of  a  few  months, 
lead  administered  for  the  third  time  caused 
paralysis :     this    was     attended     by     progressive 


TREATMENT :  CURATIVE  215 

general  emaciation  and  followed  by  death,  the 
electrical  bath  treatment  not  having  again  been 
brought  into  operation.  In  the  internal  organs, 
especially  in  the  spleen,  considerable  traces  of  lead 
were  found. 

The  points  of  professional  interest  are  the 
length  of  time  the  animal  took  lead,  three  years, 
also  the  large  quantity  of  it,  1,096  grains  of 
nitrate  ;  twice  recovery  from  paralysis,  and 
restoration  to  health  under  the  influence  of 
electrical  bath  treatment.  During  life  the 
faeces  contained  lead,  showing  that  all  the  time 
the  animal  was  receiving  lead  it  was  also  elimi- 
nating it. 

The  theory  of  the  action  of  the  double  electrical 

bath  is  as  follows :  when  an  electrical  current  is 

passed  through  a  solution  of  a  salt,  the  acid  radicle 

collects   upon    the   positive   pole    while  the   base 

NaCl 
travels  to  the  negative.    Thus  „   „^   after  passage 

Znb(J4 

CI 
of  an   electrical   current   appear    as    ^-„-    at   the 

Na 
positive  pole,  and   -^r-   at  the  negative.     The  two 
Zn 

entities  in  each  salt  are  called  ions.  They  possess 
the  power  of  traversing  membranes.  When  a  solu- 
tion containing  them  is  applied  to  the  skin,  and  an 
electrical  current  is  passed  at  the  same  time,  ioniza- 


216  LEAD  POISONING 

Hon  occurs.     Introduction  of  metallic  drugs  into 
the  human  body  by  this  means  has  been  attended 
with  distinct  success.     The  method  of  application 
is  as  follows  :  The  joint  or  limb  about  to  be  treated 
can  either  be  placed  in  a  bath  containing  the  salt 
in  solution,  or  a  pad  of  lint  soaked  in  the  medica- 
ment can  be  laid  upon  the  particular  part,  and  an 
electrode   laid    upon    it,  while   the  other   pole   is 
applied  to  an  indifferent  part  of  the  body.     If  a 
bath  is  used,  more  current  can  be  passed,  and  as 
a  consequence  more  ions  can  be  introduced.     Such 
in  a  few  words  is  ionization.     Electrical  treatment 
of    lead   poisoning    by   the   two-bath    system    is 
de-ionization.     In  this    method  of  treatment  the 
electrical   current    passes   through    the    body :    it 
breaks   up    any    lead    compound   which    may   be 
present ;  it  carries  the  acid  radicle  to  the  positive 
pole,  and  the  base  to  the  negative.     The  apparatus 
is  simple.     A  wooden  tub  is  required  for  the  feet 
of  the  workman,  and  into  it  tepid  water  is  placed, 
while  for  the  hands  and  forearms  similar  provision 
is  made.     A   series  of  tubs  can   be  arranged   so 
that  several  men  can  take  the  bath  at  one  and  the 
same  time.     The  electrical  part  of  the  apparatus 
consists  of  a  battery,  a  milliamperemeter,  and  a 
rheostat    for    regulating   electrical   pressure,    also 
wires  and  electrodes  in  the  form  of  grids.     The 
bath  is  given  for  half  an  hour  or  a  little  longer 


TREATMENT :  CURATIVE  217 

every  day  or  every  second  or  third  day,  according 
to  whether  it  is  being  used  for  curative  or 
preventive  purposes.  A  voltage  of  16  is  gener- 
ally sufficient,  and  a  milliamperage  of  20  to 
40.  The  positive  pole  is  placed  in  the  foot-bath, 
and  the  negative  in  the  arm-bath.  The  electrodes, 
made  from  aluminium,  should  be  free  from  lead. 
If  the  electrical  current,  as  regulated  by  the 
rheostat,  is  introduced  gradually,  no  shock  is  felt, 
nor  is  any  unpleasant  sensation  experienced  by 
the  men.  On  the  other  hand,  if  the  hands  or 
feet  are  brought  into  direct  contact  with  the 
electrodes  the  skin  may  become  red  and  painful, 
and  ulceration  even  may  follow.  Care  must 
therefore  be  taken  by  those  using  the  bath  that 
such  accidents  do  not  occur.  Occasionally  the 
skin  becomes  red  and  irritable  at  the  water-level 
mark,  due  to  disruption  of  the  common  salt  added 
to  the  bath-water  to  reduce  resistance  to  the 
passage  of  the  electrical  current. 

Objections  have  been  raised  in  regard  to  the 
electrolytic  treatment  of  plumbism,  the  principal 
one  being  that  there  is  no  evidence  to  show  that 
lead  can  be  removed  from  the  body.  To  that  I 
unhesitatingly  give  the  answer  that  lead  has  been 
detected  on  the  electrodes  and  in  the  water  after 
the  baths.  As  the  amount  of  lead  in  the  body  ot 
a  workman  at  any  particular  time  is  extremely 


218  LEAD  POISONING 

small  only  minute  traces  of  the  metal  can  be 
found.  One  disturbing  circumstance  in  the 
electrical  bath  treatment  of  lead  workers  is  the 
possible  presence  of  the  metal  or  its  compounds  on 
the  skin.  But  where  plumbism  is  due  to  drinking 
contaminated  water,  this  possibility  does  not  hold, 
and  yet  in  patients  thus  suffering  lead  was  found 
on  the  electrodes  and  in  the  bath-water.  Another 
source  of  lead,  apart  from  the  patient  about  to  be 
treated,  is  the  water  of  the  bath  :  this  may  have 
been  taken  from  lead  pipes  ;  and  also  there  is  the 
possibility  of  the  common  salt  which  was  added  to 
the  bath  having  contained  traces  of  lead.  But 
apart  from  these,  and  where  the  greatest  care  was 
taken  to  eliminate  all  possible  sources  of  error, 
lead  has  been  found  on  the  electrodes  and  in  the 
water  after  the  electrical  bath  treatment  of  lead 
workers. 

At  one  of  the  large  lead  works  in  Newcastle- 
upon-Tyne  an  independent  analytical  chemist, 
Mr.  H.  Dunford  Smith,  was  invited  to  arrange 
and  supervise  a  double  electrical  bath,  and  to  make 
an  analysis  of  the  grids  and  of  the  bath-water.  A 
man  who  was  working  in  the  desilvering  depart- 
ment, who  had  never  been  ill,  whose  gums  did  not 
show  a  blue  line  or  his  face  pronounced  anaemia, 
was  selected  by  Mr.  Dunford  Smith  for  the  experi- 
ment.    It  was  felt  that  the  test  was  a  severe  one, 


TREATMENT :  CURATIVE 


:t9 


there  being  so  many  men  in  the  works  more  likely 
to  have  been  absorbing  lead  than  this  desilverer. 
One  of  the  primary  requirements  was  that  the  man 
must  sit  with  feet  and  legs  in  warm  water  for  an 
hour ;  also  that  the  hands  and  forearms  must  be 
similarly  immersed.  The  water  was  then  to  be 
changed.  During  the  next  part  of  the  experiment 
the  workman's  limbs  were  simply  to  remain  in  the 
bath  as  before ;  the  bath-water  was  to  be  removed 
and  examined,  fresh  water  was  then  to  be  placed 
in  the  tubs,  and  the  electrical  current  turned  on. 
The  bath  experiment  lasted  from  one  to  two  hours 
on  two  successive  days.  During  the  two  days 
the  man  did  no  work  in  the  factory.  The  follow- 
ing is  a  copy  of  the  analysis  by  Mr.  H.  Dunford 
Smith  : 

Lead  in 


Foot  Water 

Arm  Water 

Gramme 

Gramme 

January  15 : 

Without  current  (no  salt)    ... 

0  '0005 

00006 

With  current  (100  grammes  salt)     . 

0"0044 

0^0045 

Aluminium  grids 

0*0003 

0-00033 

January  16 : 

Without  current  (no  salt)    ... 

0  0006 

OOO083 

With  current  (100  grammes  salt)   .. 

C0038 

OOO57 

Aluminium  grids 

None 

0  "00005 

The  urine  was  found  to  be  free  from  lead. 

From  this  man  there  was  removed  by  electrolysis 
I  grain  in  the  first  day's  bath,  and  in  the  second 
j-1--  grain.  This  analysis  from  an  independent  and 
disinterested  source  is  extremely  valuable. 


220  LEAD  POISONING 

It  was  only  to  be  expected  that  a  line  of  treat- 
ment of  plumbism  so  novel  in  some  respects  as 
that  recommended  by  Mr.  Clague  and  myself 
should  be  assailed  and  have  to  run  the  gauntlet  of 
criticism.  It  is  therefore  encouraging  to  learn  that 
in  the  United  States  not  only  is  the  electrical  bath 
treatment  of  lead  poisoning  well  known,  but  in  the 
hands  of  some  persons  it  has  given  satisfactory 
results.  I  extract  from  a  letter  sent  to  me  by 
Dr.  Francis  D.  Patterson,  medical  officer  to 
Messrs.  Harrison  Bros.,  white  lead  and  paint  works 
in  Philadelphia,  also  medical  officer  to  the  Electric 
Storage  Battery  Company,  dated  May  15,  1914, 
the  following  reference  to  the  points  under  con- 
sideration : 

"  Re  the  electrolytic  baths  :  I  am  using  them 
as  a  routine  method  of  prevention  at  these  works 
and  at  the  works  of  the  Electric  Storage  Battery 
Company,  and  the  results  I  am  obtaining  are  in 
every  way  most  gratifying,  so  much  so  that  I  am 
convinced  it  is  the  greatest  advance  which  has 
ever  been  made  in  dealing  with  the  problem  of  any 
occupational  disease.  I  had  a  man  who  had  acute 
lead  colic,  who  was  relieved  after  two  hours  in  the 
bath,  and  another  case,  one  of  wrist-drop,  in  which, 
after  three  weeks'  treatment,  his  paralysis  is  almost 
gone.  In  cases  where  I  am  using  it  as  a  precau- 
tion I  have  had  analysis  made  of  the  water  from 


TREATMENT :  CURATIVE  221 

the    baths,    and   the   following    are   some  of  the 
results  : 

Bath-  Water. 

Hand,  negative;  foot,  0*057  grain  lead. 
Hand,  negative  ;  foot,  0*113  ,, 

Hand,  0-087  grain  ;  foot,  0-115     » 
Hand,  negative  ;  foot,  0*453  „ 

Hand,  negative  ;  foot,  0*438  ,, 

"  I  have  a  large  number  of  equally  conclusive 
cases.  They  were  only  put  in  the  bath  after  a 
thorough  scrubbing  of  their  hands  and  feet." 

Upon  Dr.  Patterson's  unsolicited  and  favourable 
report  I  make  no  comment :  it  embodies  the 
opinion  of  a  medical  man  who  has  had  great 
experience  of  the  diagnosis  and  treatment  of 
industrial  lead  poisoning. 

The  workmen,  taken  as  a  whole,  appreciate  the 
bath.  Only  from  three  men  have  I  received  un- 
favourable opinions  :  (a)  one  said  that  he  neither 
felt  better  nor  worse  after  the  bath ;  (6)  that  it  set 
up  diarrhoea ;  (c)  that  it  made  his  skin  extremely 
irritable.  Nearly  all  the  men  have  expressed  them- 
selves as  feeling  refreshed  and  invigorated  after  the 
bath — a  feeling  of  fitness  to  which  they  had  been 
unaccustomed  for  months  previously.  In  them  the 
blue  line  on  the  gums  could  be  observed  to  be 
gradually  disappearing,  pallor  of  the  face  was  being 
replaced  by  a  ruddy  glow  of  health,  and  the  mus- 
cular power  had  considerably  improved.    The  effect 


222 


LEAD  POISONING 


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224  LEAD  POISONING 

of  the  baths  is  in  most  instances — as  shown  in  the 
charts — an  improvement  of  the  muscular  grip.  No 
uniform  result  was  noticed  as  regards  the  blood 
pressure.  It  seemed  to  raise  low  blood  pressures 
gently  and  to  reduce  gradually  those  which  were 
high.  The  double  electrical  bath  as  a  means  of 
preventing  plumbism  is  far  and  away  beyond  the 
ordinary  warm  bath  which  is  required  of  lead 
workers  weekly  by  Home  Office  regulations. 
Should  the  experience  of  other  physicians  confirm 
what  I  have  written  about  the  double  electrical 
bath,  it  might  with  great  advantage  take  the  place 
of  the  weekly  warm  bath. 

The  objection  might  be  raised  that  if  the  double 
electrical  bath  removes  lead,  might  it  not  also 
remove  other  metals  of  use  to  the  economy,  such 
as  iron,  and  thereby  tend  to  increase  any  anaemia 
which  might  be  present  ?  Mr.  Clague  and  I 
carried  out  several  experiments  to  test  this  possi- 
bility. As  lead  is  the  more  electrolyzable  metal,  it 
always  came  away  first.  In  only  a  few  instances 
was  iron  removed,  and  then  in  extremely  minute 
quantities  compared  with  lead. 

Another  thing  which  might  be  claimed  for  the 
double  electrical  bath  is  that,  since  it  removes 
lead  from  the  body,  which  is  found  in  the  bath- 
water and  on  the  electrodes,  it  might  be  used  in 
doubtful  cases  for  diagnostic  purposes. 


FACTORY  AND  WORKSHOP  ORDERS 


For  the  Process  of  File-Cutting  by  Hand* 
1903.    No.  507. 

Whereas  the  process  of  file-cutting  by  hand  has  been 
certified  in  pursuance  of  Section  79  of  the  Factory  and 
Workshop  Act,  1901,!  to  be  dangerous; 

I  hereby,  in  pursuance  of  the  powers  conferred  on  me  by 
that  Act,  make  the  following  Regulations,  and  direct  that 
they  shall  apply  to  all  factories  and  workshops  (including 
tenement  factories  and  tenement  workshops)  or  parts 
thereof  in  which  the  process  of  file-cutting  by  hand  is 
carried  on  :  Provided  that  the  Chief  Inspector  of  Factories 
may  by  certificate  in  writing  exempt  from  all  or  any  of 
these  Regulations  any  factory  or  workshop  in  which  he  is 
satisfied  that  the  beds  used  are  of  such  composition  as  not 
to  entail  danger  to  the  health  of  the  persons  employed. 

1.  The  number  of  stocks  in  any  room  shall  not  be  more 
than  one  stock  for  every  350  cubic  feet  of  air  space  in  the 
room ;  and  in  calculating  air  space  for  the  purpose  of  this 
Regulation  any  space  more  than  10  feet  above  the  room 
shall  not  be  reckoned. 

2.  After  the  1st  day  of  January,  1904,  the  distance  between 
the  stocks  measured  from  the  centre  of  one  stock  to  the 
centre  of  the  next  shall  not  be  less  than  2  feet  6  inches,  and 
after  the  1st  day  of  January,  1905,  the  said  distance  shall  not 
be  less  than  3  feet. 

*  These  Regulations  were  gazetted  June  23,  1903. 
t  1  Edw.  7,  c.  22. 

225  15 


226  LEAD  POISONING 

3.  Every  room  shall  have  a  substantial  floor,  the  whole  of 
which  shall  be  covered  with  a  washable  material,  save  that 
it  shall  be  optional  to  leave  a  space  not  exceeding  6  inches 
in  width  round  the  base  of  each  stock. 

The  floor  of  every  room  shall  be  kept  in  good  repair. 

4.  Efficient  inlet  and  outlet  ventilators  shall  be  provided 
in  every  room.  The  inlet  ventilators  shall  be  so  arranged 
and  placed  as  not  to  cause  a  direct  draught  of  incoming  air 
to  fall  on  the  workmen  employed  at  the  stocks. 

The  ventilators  shall  be  kept  in  good  repair  and  in  work- 
ing order. 

5.  No  person  shall  interfere  with  or  impede  the  working 
of  the  ventilators. 

6.  Sufficient  and  suitable  washing  conveniences  shall  be 
provided  and  maintained  for  the  use  of  the  file-cutters. 
The  washing  conveniences  shall  be  under  cover  and  shall 
comprise  at  least  one  fixed  basin  for  every  ten  or  less 
stocks.  Every  basin  shall  be  fitted  with  a  waste  pipe  dis- 
charging over  a  drain  or  into  some  receptacle  of  a  capacity 
at  least  equal  to  one  gallon  for  every  file-cutter  using  the 
basin.  Water  shall  be  laid  on  to  every  basin  either  from 
the  main  or  from  a  tank  of  a  capacity  of  not  less  than 
Itt  gallons  to  every  worker  supplied  from  such  tank.  A 
supply  of  clean  water  shall  be  kept  in  the  said  tank  while 
work  is  going  on,  at  least  sufficient  to  enable  every  worker 
supplied  from  such  tank  to  wash. 

7.  The  walls  and  ceiling  of  every  room,  except  such  parts 
as  are  painted  or  varnished  or  made  of  glazed  brick,  shall 
be  limewashed  once  in  every  six  months  ending  the  30th 
of  June  and  once  in  every  six  months  ending  the  31st  of 
December. 

8.  The  floor  and  such  parts  of  the  walls  and  ceiling  as  are 
not  limewashed  and  the  benches  shall  be  cleansed  once  a 
week. 

9.  If  the  factory  or  workshop  is  situated  in  a  dwelling- 
house  the  work  of  file-cutting  shall  not  be  carried  on  in 
any  room  which  is  used  as  a  sleeping  place  or  for  cooking 
or  eating  meals. 


FACTORY  AND    WORKSHOP  ORDERS        227 

10.  Every  file-cutter  shall  when  at  work  wear  a  long 
apron  reaching  from  the  shoulders  and  neck  to  below  the 
knees.     The  apron  shall  be  kept  in  a  cleanly  state. 

11.  A  copy  of  these  Regulations  and  an  Abstract  of  the 
provisions  of  the  Factory  and  Workshop  Act,  1901,*  shall 
be  kept  affixed  in  the  factory  or  workshop  in  a  conspicuous 
place. 

12.  It  shall  be  the  duty  of  the  occupier  to  carry  out 
Regulations  1,  2,  3,  4,  6, 7,  and  11 ;  except  that,  in  any  room 
in  a  tenement  factory  or  tenement  workshop  which  is  let 
to  more  than  one  occupier,  it  shall  be  the  duty  of  the  owner 
to  carry  out  these  Regulations,  except  the  last  clause  of 
Regulation  6,  which  shall  be  carried  out  by  the  occupiers. 

It  shall  be  the  duty  of  the  occupier  or  occupiers  to  carry 
out  Regulation  8. 

It  shall  be  the  duty  of  the  occupier  or  occupiers  and  of 
every  workman  to  observe  Regulations  5,  9,  and  10. 

These  Regulations  shall  come  into  force  on  the  1st  day 
of  September,  1903. 

A.  Akers-Douglas, 

One  of  His  Majesty's  Principal 
Secretaries  of  State. 
Home  Office,  Whitehall, 
19th  June,  1903. 

For  the  Manufacture  of  Electric  Accumulators^ 
1903.     No.  1004. 

Whereas  the  manufacture  of  electric  accumulators  has 
been  certified  in  pursuance  of  Section  79  of  the  Factory 
and  Workshop  Act,  1901,$  to  be  dangerous  ; 

I  hereby,  in  pursuance  of  the  powers  conferred  on  me  by 
that  Act,  make  the  following  Regulations,  and  direct  that 
they  shall  apply  to  all  factories  and  workshops  or  parts 
thereof  in  which  electric  accumulators  are  manufactured. 

*  1  Edw.  7,  c.  22. 

t  These  Regulations  were  gazetted  November  24,  1903. 

X  1  Edw.  7,  c.  22. 


228  LEAD  POISONING 

In  these  Regulations  "  lead  process"*  means  pasting,  cast- 
ing, lead  burning,  or  any  work  involving  contact  with  dry 
compounds  of  lead. 

Any  approval  given  by  the  Chief  Inspector  of  Factories 
in  pursuance  of  these  Regulations  shall  be  given  in  writing, 
and  may  at  any  time  be  revoked  by  notice  in  writing  signed 
by  him. 

Duties  of  Occupier. 

i.  Every  room  in  which  casting,  pasting,  or  lead  burning 
is  carried  on  shall  contain  at  least  500  cubic  feet  of  air 
space  for  each  person  employed  therein,  and  in  computing 
this  air  space,  no  height  above  14  feet  shall  be  taken  into 
account. 

These  rooms  and  that  in  which  the  plates  are  formed, 
shall  be  capable  of  through  ventilation.  They  shall  be 
provided  with  windows  made  to  open. 

2.  Each  one  of  the  following  processes  shall  be  carried 
on  in  such  manner  and  under  such  conditions  as  to  secure 
effectual  separation  from  one  another  and  from  any  other 
process  : 

(a)  Manipulation  of  dry  compounds  of  lead ; 

(b)  Pasting; 

(c)  Formation,  and  lead  burning  necessarily  carried  on 

therewith ; 

(d)  Melting  down  of  old  plates. 

Provided  that  manipulation  of  dry  compounds  of  lead 
carried  on  as  in  Regulation  5  (b)  need  not  be  separated 
from  pasting. 

3.  The  floors  of  the  rooms  in  which  manipulation  of  dry 
compounds  of  lead  or  pasting  is  carried  on  shall  be  of 
cement  or  similar  impervious  material,  and  shall  be  kept 
constantly  moist  while  work  is  being  done. 

The  floors  of  these  rooms  shall  be  washed  with  a  hose 
pipe  daily. 

*  The  term  "lead  process"  to  which  a  defined  meaning  is 
given  is  printed  throughout  in  italics. 


FACTORY  AND  WORKSHOP  ORDERS        229 

4.  Every  melting  pot  shall  be  covered  with  a  hood  and 
shaft  so  arranged  as  to  remove  the  fumes  and  hot  air  from 
the  workrooms. 

Lead  ashes  and  old  plates  shall  be  kept  in  receptacles 
specially  provided  for  the  purpose. 

5.  Manipulation  of  dry  compounds  of  lead  in  the  mixing 
of  the  paste  or  other  processes,  shall  not  be  done  except 
(a)  in  an  apparatus  so  closed,  or  so  arranged  with  an 
exhaust  draught,  as  to  prevent  the  escape  of  dust  into  the 
workroom ;  or  (b)  at  a  bench  provided  with  (1)  efficient 
exhaust  draught  and  air  guide  so  arranged  as  to  draw  the 
dust  away  from  the  worker,  and  (2)  a  grating  on  which 
each  receptacle  of  the  compound  of  lead  in  use  at  the  time 
shall  stand. 

6.  The  benches  at  which  pasting  is  done  shall  be  covered 
with  sheet  lead  or  other  impervious  material,  and  shall  have 
raised  edges. 

7.  No  woman,  young  person,  or  child  shall  be  employed 
in  the  manipulation  of  dry  compounds  of  lead  or  in  pasting. 

8.  (a)  A  duly  qualified  medical  practitioner  (in  these 
Regulations  referred  to  as  the  "Appointed  Surgeon  ")  who 
may  be  the  Certifying  Surgeon,  shall  be  appointed  by  the 
occupier,  such  appointment  unless  held  by  the  Certifying 
Surgeon  to  be  subject  to  the  approval  of  the  Chief  In- 
spector of  Factories. 

(b)  Every  person  employed  in  a  lead  process  shall  be 
examined  once  a  month  by  the  Appointed  Surgeon,  who 
shall  have  power  to  suspend  from  employment  in  any  lead 
process. 

(c)  No  person  after  such  suspension  shall  be  employed 
in  a  lead  process  without  written  sanction  entered  in  the 
Health  Register  by  the  Appointed  Surgeon.  It  shall  be 
sufficient  compliance  with  this  Regulation  for  a  written 
certificate  to  be  given  by  the  Appointed  Surgeon  and 
attached  to  the  Health  Register,  such  certificate  to  be 
replaced  by  a  proper  entry  in  the  Health  Register  at  the 
Appointed  Surgeon's  next  visit. 

(d)  A  Health  Register  in  a  form  approved  by  the  Chief 


230  LEAD  POISONING 

Inspector  of  Factories  shall  be  kept,  and  shall  contain  a  list 
of  all  persons  employed  in  lead  processes.  The  Appointed 
Surgeon  will  enter  in  the  Health  Register  the  dates  and 
results  of  his  examinations  of  the  persons  employed  and 
particulars  of  any  directions  given  by  him.  He  shall  on  a 
prescribed  form  furnish  to  the  Chief  Inspector  of  Factories 
on  the  ist  day  of  January  in  each  year  a  list  of  the  persons 
suspended  by  him  during  the  previous  year,  the  cause  and 
duration  of  such  suspension,  and  the  number  of  examina- 
tions made. 

The  Health  Register  shall  be  produced  at  any  time  when 
required  by  H.M.  Inspectors  of  Factories  or  by  the  Certify- 
ing Surgeon  or  by  the  Appointed  Surgeon. 

9.  Overalls  shall  be  provided  for  all  persons  employed  in 
manipulating  dry  compounds  of  lead  or  in  pasting. 

The  overalls  shall  be  washed  or  renewed  once  every 
week. 

10.  The  occupier  shall  provide  and  maintain — 

{a)  A  cloakroom  in  which  workers  can  deposit  clothing 
put  off  during  working  hours.  Separate  and 
suitable  arrangements  shall  be  made  for  the 
storage  of  the  overalls  required  in  Regulation  9. 

(b)  A  dining-room  unless  the  factory  is  closed  during 
meal  hours. 

1 1.  No  person  shall  be  allowed  to  introduce,  keep,  prepare 
or  partake  of  any  food,  drink,  or  tobacco,  in  any  room  in 
which  a  lead  process  is  carried  on.  Suitable  provisions  shall 
be  made  for  the  deposit  of  food  brought  by  the  workers. 

This  Regulation  shall  not  apply  to  any  sanitary  drink 
provided  by  the  occupier  and  approved  by  the  Appointed 
Surgeon. 

12.  The  occupier  shall  provide  and  maintain  for  the  use 
of  the  persons  employed  in  lead  processes  a  lavatory,  with 
soap,  nail  brushes,  towels,  and  at  least  one  lavatory  basin 
for  every  five  such  persons.  Each  such  basin  shall  be 
provided  with  a  waste  pipe,  or  the  basins  shall  be  placed 
on  a  trough  fitted  with  a  waste  pipe.  There  shall  be  a 
constant  supply  of  hot  and  cold  water  laid  on  to  each  basin. 


FACTORY' AND  WORKSHOP  ORDERS        231 

Or,  in  the  place  of  basins  the  occupier  shall  provide  and 
maintain  troughs  of  enamel  or  similar  smooth  impervious 
material,  in  good  repair,  of  a  total  length  of  two  feet  for 
every  five  persons  employed,  fitted  with  waste  pipes,  and 
without  plugs,  with  a  sufficient  supply  of  warm  water  con- 
stantly available. 

The  lavatory  shall  be  kept  thoroughly  cleansed  and  shall 
be  supplied  with  a  sufficient  quantity  of  clean  towels  once 
every  day. 

13.  Before  each  meal  and  before  the  end  of  the  day's 
work,  at  least  ten  minutes,  in  addition  to  the  regular  meal 
times,  shall  be  allowed  for  washing  to  each  person  who  has 
been  employed  in  the  manipulation  of  dry  compounds  of 
lead  or  in  pasting. 

Provided  that  if  the  lavatory  accommodation  specially 
reserved  for  such  persons  exceeds  that  required  by  Regula- 
tion 12,  the  time  allowance  may  be  proportionately  reduced, 
and  that  if  there  be  one  basin  or  two  feet  of  trough  for 
each  such  person  this  Regulation  shall  not  apply. 

14.  Sufficient  bath  accommodation  shall  be  provided  for 
all  persons  engaged  in  the  manipulation  of  dry  compounds 
of  lead  or  in  pasting,  with  hot  and  cold  water  laid  on,  and 
a  sufficient  supply  of  soap  and  towels. 

This  rule  shall  not  apply  if  in  consideration  of  the  special 
circumstances  of  any  particular  case,  the  Chief  Inspector 
of  Factories  approves  the  use  of  local  public  baths  when 
conveniently  near,  under  the  conditions  (if  any)  named  in 
such  approval. 

15.  The  floors  and  benches  of  each  workroom  shall  be 
thoroughly  cleansed  daily,  at  a  time  when  no  other  work  is 
being  carried  on  in  the  room. 

Duties  of  Persons  Employed. 

16.  All  persons  employed  in  lead  processes  shall  present 
themselves  at  the  appointed  times  for  examination  by  the 
Appointed  Surgeon  as  provided  in  Regulation  8. 

No  persons  after  suspension  shall  work  in  a  lead  process, 


232  LEAD  POISONING 

in  any  factory  or  workshop  in  which  electric  accumulators 
are  manufactured,  without  written  sanction  entered  in  the 
Health  Register  by  the  Appointed  Surgeon. 

17.  Every  person  employed  in  the  manipulation  of  dry 
compounds  of  lead  or  in  pasting  shall  wear  the  overalls 
provided  under  Regulation  9.  The  overalls,  when  not  being 
worn,  and  clothing  put  off  during  working  hours,  shall  be 
deposited  in  the  places  provided  under  Regulation  10. 

18.  No  person  shall  introduce,  keep,  prepare,  or  partake 
of  any  food,  drink  (other  than  any  sanitary  drink  provided  by 
the  occupier  and  approved  by  the  Appointed  Surgeon),  or 
tobacco,  in  any  room  in  which  a  lead  process  is  carried  on. 

19.  No  person  employed  in  a  lead  process  shall  leave  the 
premises  or  partake  of  meals  without  previously  and  care- 
fully Gleaning  and  washing  the  hands. 

20.  Every  person  employed  in  the  manipulation  of  dry 
compounds  of  lead  or  in  pasting  shall  take  a  bath  at  least 
once  a  week. 

21.  No  person  shall  in  any  way  interfere,  without  the 
concurrence  of  the  occupier  or  manager,  with  the  means 
and  appliances  provided  for  the  removal  of  the  dust  or 
fumes,  and  for  the  carrying  out  of  these  Regulations. 

These  Regulations  shall  come  into  force  on  the  1st  day 
of  January,  1904. 

A.  Akers-Douglas, 
One  of  His  Majesty's  Principal 
Secretaries  of  State. 
Home  Office,  Whitehall, 
21st  November,  1903. 

For  the  Manufacture  of  Paints  and  Colours  * 
1907.    No.  17. 

Whereas  the  manufacture  of  paints  and  colours  has  been 
certified  in  pursuance  of  Section  79  of  the  Factory  and 
Workshop  Act,  1901^  to  be  dangerous  ; 

*  These  Regulations  were  gazetted  January  25,  1907. 
+  1  Edw.  7,  c.  22. 


FACTORY  AND  WORKSHOP  ORDERS        233 

I  hereby  in  pursuance  of  the  powers  conferred  on  me  by 
that  Act  make  the  following  Regulations,  and  direct  that 
they  shall  apply  to  all  factories  and  workshops  in  which  dry 
carbonate  of  lead  or  red  lead  is  used  in  the  manufacture  of 
paints  and  colours  or  chromate  of  lead  is  produced  by 
boiling,  provided  as  follows  ; 

(1)  The  Regulations  shall  not  apply  to  factories  and 
workshops  in  which  paints  and  colours  are  manufactured, 
not  for  sale,  but  solely  for  use  in  the  business  of  the 
occupier ;  or  to  factories  or  workshops  in  which  only  the 
manufacture  of  artists'  colours  is  carried  on  ;  or  to  the 
manufacture  of  varnish  paints. 

(2)  Regulation  2,  and  so  much  of  Regulation  3  as  prevents 
the  employment  of  a  woman  in  manufacturing  lead  colour, 
shall  not  apply  to  the  packing  in  parcels  or  kegs  not  ex- 
ceeding 14  lb.  in  weight,  unless  and  until  so  required  by 
notice  in  writing  from  the  Chief  Inspector  of  Factories. 

(3)  Regulations  4,  5,  6,  11,  and  12  shall  not  apply  to 
factories  or  workshops  in  which  the  grinding  of  lead  colour 
occupies  less  than  three  hours  in  any  week,  unless  and  until 
so  required  by  notice  in  writing  from  the  Chief  Inspector 
of  Factories. 

Definitions.* 

For  the  purpose  of  these  Regulations — 

"  Lead  colour ''  means  dry  carbonate  of  lead  and  red 
lead,  and  any  colour  into  which  either  of  these 
substances  enters. 
"  Lead  process  "  means  any  process  involving  the  mixing, 
crushing,  sifting,  grinding  in  oil,  or  any  other 
manipulation  of  lead  colour  giving  rise  to  dust  ; 
or     the     manufacture     and      manipulation     of 
chromate  of  lead  produced  by  boiling  in    the 
colour  house. 
It  shall  be  the  duty  of  the  occupier  to  observe  Part  I.  of 
these  Regulations. 

*  The  terms  "lead  colour"  and  "lead  process"  to  which 
defined  meanings  are  given  are  printed  throughout  in  italics. 


234  LEAD  POISONING 

It  shall  be  the  duty  of  all  persons  employed  to  observe 
Part  II.  of  these  Regulations. 

Part  I. 

Duties  of  Employers. 

i.  No  lead  colour  shall  be  placed  in  any  hopper  or  shoot 
without  an  efficient  exhaust  draught  and  air  guide  so 
arranged  as  to  draw  the  dust  away  from  the  worker  as  near 
as  possible  to  the  point  of  origin. 

2.  No  lead  process  shall  be  carried  on,  save  either — 

(a)  with  an  efficient  exhaust  draught  and  air  guide  so 
arranged  as  to  carry  away  the  dust  or  steam  as 
near  as  possible  to  the  point  of  origin  ;  or 

(6)  in  the  case  of  processes  giving  rise  to  dust,  in  an 
apparatus  so  closed  as  to  prevent  the  escape  of 
dust. 

Provided  that  this  Regulation  shall  not  apply  to  the 
immersion  and  manipulation  of  lead  colour  in  water. 

3.  No  woman,  young  person,  or  child  shall  be  employed 
in  manipulating  lead  colour. 

4.  Every  person  employed  in  a  lead  process  or  at  the 
roller  mills  connected  with  the  grinding  in  oil  of  lead  colour 
(hereinafter  referred  to  as  the  roller  mills  *)  shall  once  in 
each  calendar  month,  on  a  date  of  which  notice  shall  be 
given  to  every  such  person,  be  examined  by  the  Certifying 
Surgeon  of  the  district  or  other  duly  qualified  medical  prac- 
titioner (hereinafter  referred  to  as  the  Appointed  Surgeon) 
if  appointed  for  the  purpose  by  the  Chief  Inspector  of 
Factories  by  a  certificate  under  his  hand  and  subject  to 
such  conditions  as  may  be  specified  in  that  certificate. 

The  Certifying  or  Appointed  Surgeon  shall  have  power 
to  suspend  from  employment  in  any  lead  process  or  at  the 
roller  mills. 

5.  No  person  after  suspension  in  accordance  with  Regula- 

*  The  term  "roller  mills"  to  which  a  defined  meaning  is 
given  is  printed  throughout  in  italics. 


FACTORY  AND  WORKSHOP  ORDERS        235 

tion  4  shall  be  employed  in  any  lead  process  or  at  the  roller 
mills  without  written  sanction  entered  in  the  Health 
Register  by  the  Certifying  or  Appointed  Surgeon. 

6.  A  Health  Register  in  a  form  approved  by  the  Chief 
Inspector  of  Factories  shall  be  kept  and  shall  contain  a  list 
of  all  persons  employed  in  any  lead  process  or  at  the  roller 
mills.  The  Certifying  or  Appointed  Surgeon  will  enter 
therein  the  dates  and  results  of  his  examinations  of  such 
persons  with  particulars  of  any  directions  given  by  him. 

The  Health  Register  shall  be  produced  at  any  time  when 
required  by  any  of  His  Majesty's  Inspectors  of  Factories  or 
by  the  Certifying  or  Appointed  Surgeon. 

7.  Overalls  shall  be  provided  for  all  persons  employed  in 
lead  processes  or  at  the  roller  mills  ;  and  shall  be  washed  or 
renewed  at  least  once  every  week. 

8.  The  occupier  shall  provide  and  maintain  for  the  use 
of  all  persons  employed  in  lead  processes  or  at  the  roller 
mills — 

(a)  a  cloakroom  or  other  suitable  place  in  which  such 

persons  can  deposit  clothing  put  off  during 
working  hours,  and  separate  and  suitable 
arrangements  for  the  storage  of  overalls  required 
by  Regulation  7  ; 

(b)  a  dining-room,  unless  all  workers  leave  the  factory 

during  meal  hours. 

9.  No  person  shall  be  allowed  to  introduce,  keep,  prepare, 
or  partake  of  any  food,  drink  (other  than  a  medicine  pro- 
vided by  the  occupier  and  approved  by  the  Certifying  or 
Appointed  Surgeon),  or  tobacco  in  any  room  in  which  a 
lead  process  is  carried  on.  Suitable  provision  shall  be  made 
for  the  deposit  of  food  brought  by  persons  employed. 

10.  The  occupier  shall  provide  and  maintain  in  a  cleanly 
state  and  in  good  repair  for  the  use  of  persons  employed  in 
lead  processes  or  at  the  roller  mills  a  lavatory  containing 
either — 

(a)  at  least  one    lavatory    basin   for    even-    five   such 
persons,  fitted  with  a  waste  pipe,  or  placed  in  a 


236  LEAD  POISONING 

trough  having  a  waste  pipe,  and  having  a  constant 
supply  of  cold  water  laid  on  and  a  sufficient 
supply  of  hot  water  constantly  available  ;  or 
(b)  troughs  of  enamel  or    similar  smooth  impervious 
material,  fitted  with  waste  pipes  without  plugs, 
and   having  a  constant  supply  of   warm  water 
laid  on.     The  length  of  such  troughs  shall  be  in 
a  proportion  of  not  less  than  two  feet  for  every 
five  persons  employed  in  lead  processes  or  at  the 
roller  mills. 
He  shall  also  provide  in  the  lavatory  soap,  nail  brushes, 
and  a  sufficient  supply  of  clean  towels  renewed  daily. 

Part  II. 

Duties  of  Persons  Employed. 

11.  All  persons  employed  in  lead  processes  or  at  the  roller 
mills  shall  present  themselves  at  the  appointed  time  for 
examination  by  the  Certifying  or  Appointed  Surgeon  as 
provided  in  Regulation  4. 

12.  No  person  after  suspension  under  Regulation  4  shall 
work  in  a  lead  process  or  at  the  1  oiler  mills  in  any  paint  and 
colour  factory  or  workshop  to  which  these  Regulations  apply 
without  written  sanction  entered  in  the  Health  Register  by 
the  Certifying  or  Appointed  Surgeon. 

13.  All  persons  employed  in  lead  processes  or  at  the  roller 
mills  shall  wear  the  overalls  provided  under  Regulation  7 
and  shall  deposit  such  overalls  and  any  clothing  put  off 
during  working  hours  in  the  places  provided  under  Regula- 
tion 8. 

The  overalls  shall  not  be  removed  by  persons  employed 
from  the  factory  or  worshop. 

14.  No  person  shall  introduce,  keep,  prepare,  or  partake 
of  any  food,  drink  (other  than  a  medicine  provided  by  the 
occupier  and  approved  by  the  Certifying  or  Appointed 
Surgeon),  or  tobacco  in  any  room  in  which  a  lead  process  is 
carried  on. 

15.  All  persons  employed  in  lead  processes  or  at  the   roller 


FACTORY  AND  WORKSHOP  ORDERS        237 

mills  shall  carefully  clean   and  wash  their   hands   before 
leaving  the  premises  or  partaking  of  any  food. 

16.  No  person  shall,  without  the  permission  of  the 
occupier  or  manager,  interfere  in  any  way  with  the  means 
and  appliances  provided  for  the  removal  of  dust,  steam,  or 
fumes,  and  for  the  carrying  out  of  these  Regulations. 

These  Regulations  shall  come  into  force  on  1st  February  , 
1907. 

H.  J.  Gladstone, 

One  of  His  Majesty's  Principal 
Secretaries  of  State. 
Home  Office,  Whitehall, 
January  21,  1907. 

For  the  Heading  of  Yarn  dyed  by  Means  of  a 

Lead   Compound* 

1907.     No.  616. 

Whereas  the  process  of  heading  of  yarn  dyed  by  means 
of  a  lead  compound  has  been  certified  in  pursuance  of 
Section  79  of  the  Factory  and  Workshop  Act,  1901,!  to  be 
dangerous ; 

I  hereby,  in  pursuance  of  the  powers  conferred  on  me 
by  that  Act,  make  the  following  Regulations,  and  direct  that 
they  shall  apply  to  all  factories  in  which  the  said  process  is 
carried  on. 

Provided  that  if  the  Chief  Inspector  of  Factories  is  satis- 
fied, with  regard  to  any  such  factory,  that  the  heading  of 
yarn  dyed  by  means  of  a  lead  compound  will  not  occupy 
more  than  three  hours  in  any  week,  he  may,  by  certificate, 
suspend  Regulations  2,  3,  4,  7  (a),  and  8  (a),  or  any  of  them. 
Every  such  certificate  shall  be  in  writing,  signed  by  the 
Chief  Inspector  of  Factories,  and  shall  be  revocable  at  any 
time  by  further  certificate. 

*  These  Regulations  were  gazetted  August  13,  1907. 
•j-  1  Edw.  7,  c.  22. 


238  LEAD  POISONING 

Definitions.* 

"Heading"  means  the  manipulation  of  yarn  dyed  by 
means  of  a  lead  compound  over  a  bar  or  post,  and  includes 
picking,  making-up,  and  noddling. 

"  Employed  "  means  employed  in  heading  of  yarn  dyed 
by  means  of  a  lead  compound. 

"  Surgeon  "  means  the  Certifying  Factory  Surgeon  of  the 
district  or  a  duly  qualified  medical  practitioner  appointed 
by  certificate  under  the  hand  of  the  Chief  Inspector  of 
Factories,  which  appointment  shall  be  subject  to  such  con- 
ditions as  may  be  specified  in  that  certificate. 

"  Suspension  "  means  suspension  by  written  certificate  in 
the  Health  Register,  signed  by  the  Surgeon,  from  employ- 
ment in  heading  of  yarn  dyed  by  means  of  a  lead  com- 
pound. 

Duties. 

It  shall  be  the  duty  of  the  occupier  to  observe  Part  I.  of 
these  Regulations. 

It  shall  be  the  duty  of  all  persons  employed  to  observe 
Part  II.  of  these  Regulations. 

Part  I. 

Duties  of  Employers. 

i.  No  yarn  dyed  by  means  of  a  lead  compound  shall  be 
headed  unless  there  be  an  efficient  exhaust  draught  so 
arranged  as  to  draw  the  dust  away  from  the  worker,  as  near 
as  possible  to  the  point  of  origin.  The  speed  of  the  draught 
at  the  exhaust  opening  shall  be  determined  at  least  once  in 
every  three  months  and  recorded  in  the  General  Register. 

2.  No  person  under  16  years  of  age  shall  be  employed. 

3.  A  Health  Register,  containing  the  names  of  all  persons 
employed,  shall  be  kept  in  a  form  approved  by  the  Chief 
Inspector  of  Factories. 

*  Terms  to  which  defined  meanings  are  given  are  printed 
throughout  in  italics. 


FACTORY  AND   WORKSHOP  ORDERS        239 

4.  Every  person  employed  shall  be  examined  by  the 
Surgeon  once  in  every  three  months  (or  at  shorter  intervals 
if  and  as  required  in  writing  by  the  Chief  Inspector  of 
Factories)  on  a  date  of  which  due  notice  shall  be  given  to 
all  concerned. 

The  Surgeon  shall  have  power  of  suspension  as  regards  all 
persons  employed,  and  no  person  after  suspension  shall  be 
employed  without  written  sanction  from  the  Surgeon  entered 
in  the  Health  Register. 

5.  There  shall  be  provided  and  maintained  for  the  use  of 
all  persons  employed — 

(a)  a  suitable  cloakroom  for  clothing  put  off  during 

working  hours ; 

(b)  a  suitable  meal-room   separate  from  any  room  in 

which  heading  of  yarn  dyed  by  means  of  a  lead 
compound  is  carried  on,  unless  the  works  are 
closed  during  meal  hours  ; 

and,  if   so  required  by  notice  in  writing  from  the  Chief 
Inspector  of  Factories, 

(c)  suitable  overalls  and  head-coverings  which  shall  be 

collected  at  the  end  of  every  day's  work,  and  be 
washed  and  renewed  at  least  once  every  week ; 

(d)  a  suitable  place,  separate  from  the  cloakroom  and 

meal-room,  for  the  storage  of  the  overalls  and 
head-coverings. 

6.  There  shall  be  provided  and  maintained  in  a  cleanly 
state  and  in  good  repair,  for  the  use  of  all  persons  employed, 
a  lavatory,  under  cover,  with  a  sufficient  supply  of  clean 
towels,  renewed  daily,  and  of  soap  and  nail  brushes,  and 
with  either — 

(a)  a  trough  with  a  smooth  impervious  surface,  fitted 
with  a  waste  pipe  without  plug,  and  of  such 
length  as  to  allow  at  least  two  feet  for  every  five 
such  persons,  and  having  a  constant  supply  of 
warm  water  from  taps  or  jets  above  the  trough 
at  intervals  of  not  more  than  two  feet ;  or 


240  LEAD  POISONING 

(b)  at  least  one  lavatory  basin  for  every  five  such 
persons,  fitted  with  a  waste  pipe  and  plug  or 
placed  in  a  trough  having  a  waste  pipe,  and 
having  either  a  constant  supply  of  hot  and  cold 
water  or  warm  water  laid  on,  or  (if  a  constant 
supply  of  heated  water  be  not  reasonably  prac- 
ticable) a  constant  supply  of  cold  water  laid  on 
and  a  supply  of  hot  water  always  at  hand  when 
required  for  use  by  persons  employed. 


Part  II. 

Ditties  of  Persons  Employed. 

7.  Every  person  employed  shall — 

(a)  present  himself  at  the  appointed  time  for  examina- 

tion by  the  Surgeon  as  provided  in  Regulation  4 ; 

(b)  wear  the  overall  and   head-covering  (provided  in 

pursuance  of  Regulation  5  (c)  )  while  at  work, 
and  shall  remove  them  before  partaking  of  food 
or  leaving  the  premises,  and  shall  deposit  in  the 
cloakroom,  provided  in  pursuance  of  Regula- 
tion 5  (a),  clothing  put  off  during  working  hours  ; 

(c)  wash  the  hands  before  partaking  of  food  or  leaving 

the  premises. 

8.  No  person  shall — 

(a)  work  in  heading  of  yarn  dyed  by  means  of  a  lead 

compound  after  suspension,  without  written 
sanction  from  the  Surgeon  entered  in  the  Health 
Register ; 

(b)  introduce,  keep,  prepare,  or  partake  of  any  food  or 

drink,  or  tobacco,  in  any  room  in  which  heading 
of  yarn  dyed  by  means  of  a  lead  compound  is 
carried  on ; 

(c)  interfere  in  any  way,  without  the  concurrence  of  the 

occupier  or  manager,  with  the  means  and  appli- 


FACTORY  AND   WORKSHOP  ORDERS        241 

ances  provided  for  the  removal  of  the  dust,  and 
for  the  carrying  out  of  these  Regulations. 

H.  J.  Gladstone, 
One  of  His  Majesty's  Principal 
Secretaries  of  State. 
Home  Office,  Whitehall, 
6th  August,  1907. 

For  the  Smelting  of  Materials  containing  Lead,  the 
Manufacture  of   Red  or  Orange  Lead,  and  the 
Manufacture  of  Flaked  Litharge* 
1911.    No.  752. 

In  pursuance  of  Section  79  of  the  Factory  and  Workshop 
Act,  1901,^  I  hereby  make  the  following  Regulations,  and 
direct  that  they  shall  apply  to  all  factories  and  workshops 
or  parts  thereof  (other  than  laboratories),  in  which  any  of 
the  following  processes  are  carried  on  : — 

THE  SMELTING  OF  MATERIALS  CONTAINING  LEAD  ; 
THE  MANUFACTURE  OF  RED  OR  ORANGE  LEAD  ; 
THE  MANUFACTURE  OF  FLAKED  LITHARGE. 

These  Regulations  shall  come  into  force  on  October  1st, 
191 1,  except  that  so  much  of  Regulations  2  and  3  as 
requires  the  provision  of  efficient  exhaust  draught  shall  come 
nto  force  on  May  ist,  19 12. 

Definitions.^ 

In  these  Regulations  : — 

"Lead  material"  means — 

(i.)  material  containing  not  less  than  five  per  cent,  of 
lead,  including  lead  ore,  bullion  ore  (lead  ore 
rich  in  precious  metals),  red  lead,  orange  lead, 
and  flaked  litharge,  and 

*  These  Regulations  were  gazetted  August  18,  1911. 
t  1  Edw.  7,  c.  22. 

X  Terms  to  which  defined  meanings  are  given  are  printed 
throughout  the  Regulations  in  italics. 

16 


242  LEAD  POISONING 

(ii.)  zinc  ore,  and  material  resulting  from  the  treatment 
thereof,  containing  not  less  than  two  per  cent, 
of  lead  ; 

except  ores  which  contain  lead  only  in  the  form  of  sulphide 
of  lead. 

"Furnace,"  "  melting  pot,"  •"  retort,"  "  condensing  chamber," 
mean  structures  as  aforesaid  which  are  used  in  the  treatment 
of  lead  material. 

"  Flue  "  means  a  flue  leading  from  a  furnace. 

"  Lead  process  "  means — 

(i.)  manipulation,  movement  or  other  treatment  of  lead 
material,  whether  by  means  of  any  furnace, 
melting  pot,  retort,  condensing  chamber,  flue,  or 
otherwise ;  and 

(ii.)  cleaning  or  demolition  of  any  furnace,  melting  pot, 
retort,  condensing  chamber,  flue,  or  part  thereof 
or  reconstruction  thereof  with  material  which 
has  formed  part  of  any  such  structure. 

"Surgeon"  means  the  Certifying  Factory  Surgeon  of  the 
district  or  a  duly  qualified  medical  practitioner  appointed 
by  written  certificate  of  the  Chief  Inspector  of  Factories, 
which  appointment  shall  be  subject  to  such  conditions  as 
may  be  specified  in  that  certificate. 

"  Suspension  "  means  suspension  from  employment  in  any 
lead  process  by  written  certificate  in  the  Health  Register, 
signed  by  the  Surgeon,  who  shall  have  power  of  suspension 
as  regards  all  persons  employed  in  any  lead  process. 

"  Damp  "  means  sufficiently  moist  to  prevent  the  escape 
of  dust. 

"Efficient  exhaust  draught"  means  localized  ventilation 
effected  by  heat  or  mechanical  means,  for  the  removal  of 
gas,  vapour,  fumes  or  dust  so  as  to  prevent  them  (as  far  as 
practicable  under  the  atmospheric  conditions  usually  pre- 
vailing) from  escaping  into  the  air  of  any  place  in  which 
work  is  carried  on.  No  draught  shall  be  deemed  efficient 
which  fails  so  to  remove  smoke  generated  at  the  point 
where  such  gas,  vapour,  fumes  or  dust  originate. 


FACTORY  AND  WORKSHOP  ORDERS        243 

Duties. 

It  shall  be  the  duty  of  the  occupier  to  observe  Part  I.  of 
these  Regulations. 

It  shall  be  the  duty  of  every  person  employed  to  observe 
Part  II.  of  these  Regulations. 

Part  I. — Duties  of  Occupiers. 

1.  Where  a  lead  process  is  carried  on  so  as  to  give  rise  to 
dust  or  fumes, 

(a)  the  floor,  other  than  sand  beds,  shall  be  maintained 

in  good  condition  ;  and 

(b)  the  floor,  except  such  portion  as  is  permanently  set 

apart  for  the  deposit  of  lead  material,  shall  be 
sprayed  with  water  at  least  once  a  day. 

2.  (1)  No  lead  material  (other  than  ingots  of  metal) 
shall  be  deposited  or  allowed  to  remain  on  any  part  of  the 
floor  not  permanently  set  apart  for  the  purpose,  and  no  lead 
material  (other  than  ingots  of  metal)  shall  be  moved  to  a 
furnace,  unless  such  lead  material  is — 

(a)  damp ;  or 

(b)  under  an  efficient  exhaust  draught ;  or 

(c)  so  enclosed  as  to  prevent  the  escape  of  dust  into  the 

air  of  any  place  in  which  work  is  carried  on. 

(2)  Provided,  however,  that  where  none  of  the  above 
conditions  are  practicable,  lead  material  may  be  moved  to  a 
furnace  by  persons  wearing  suitable  respirators. 

3.  None  of  the  following  processes  shall  be  carried  on 
except  with  an  efficient  exhaust  draught  : — 

melting  old  or  dirty  scrap  lead  ; 

heating  lead  material  so  that  vapour  containing  lead  is 

given  off  ; 
cooling  molten  flaked  litharge  ; 

or,  unless  carried  on  in  such  manner  as  to  prevent  escape 
of  gas,  vapour,  fumes  or  dust  into  any  place  in  which  work 
is  carried  on — 


244  LEAD  POISONING 

feeding  any  furnace  or  retort  ; 

manipulating  lead  material  in  any  furnace  or  retort ; 
removing  lead  material  from  any  furnace  or  retort  ; 
placing  in   any   hopper  or  shoot,  or  packing,  red  or 
orange  lead  or  flaked  litharge. 

4.  No  sack  which  has  contained  lead  material  shall  be 
cleaned,  and,  except  in  the  process  of  sampling,  no  lead 
material  shall  be  broken  up,  crushed  or  ground,  unless 
such  sack  or  lead  material  is  damp,  or  is  placed  in  an 
apparatus  so  enclosed  as  to  prevent  the  escape  of  dust. 

5.  No  lead  material  giving  off  vapour  containing  lead  shall 
be  removed  from  the  efficient  exhaust  draught  required  by 
Regulation  3,  unless  in  a  receptacle  with  an  efficient  cover. 

6.  No  person  shall  be  allowed  to  enter  any  furnace,  melt- 
ing pot,  retort,  condensing  chamber,  or  Hue,  until  it  has  been 
ventilated. 

7.  No  person  shall  be  allowed  to  remain  in  any  flue 
(unless  damp)  or  condensing  chamber  for  more  than  three 
hours  without  an  interval  of  at  least  half  an  hour. 

8.  There  shall  be  provided  suitable  overalls  for  the  use  of 
all  persons  employed  in  any  of  the  following  processes ; 
which  overalls,  when  required  for  such  use,  shall  be 
washed,  cleaned  or  renewed  at  least  once  every  week  : — 

(a)  cleaning    any  flue    (unless    damp)    or   condensing 

chamber  ; 

(b)  demolishing  any  part   of    a  furnace,   melting  pot, 

retort,  condensing  chamber,  or  flue,  unless  either 
damp  or  under  an  efficient  exhaust  draught ; 

(c)  reconstructing  any  part  of  a  furnace,  melting  pot, 

retort,  condensing  chamber,  or  flue,  with  material 

which  has  formed  part  of  any  such  structure, 

unless  damp  ; 
{d)  breaking  up,  crushing,  or  grinding,  in  the  process 

of  sampling,  lead  material,  unless  either  damp  or 

placed  in  an  apparatus  so  enclosed  as  to  prevent 

the  escape  of  dust  ; 
(e)  placing  in  any  hopper  or  shoot,  or  packing,  red  or 

orange  lead  or  flaked  litharge. 


FACTORY  AND   WORKSHOP  ORDERS        245 

9.  There  shall  be  provided  suitable  respirators  for  the 
use  of  all  persons  employed  in  any  process  named  in 
Regulation  2  (2)  or  in  Regulation  8  ;  which  respirators, 
when  required  for  such  use,  shall  be  washed  or  renewed  at 
least  once  every  day. 

10.  No  person  under  16  years  of  age,  and  no  female,  shall 
be  employed  in  any  lead  process. 

11.  There  shall  be  provided  and  maintained  for  the  use 
of  all  persons  employed  in  any  lead  process  : — 

(a)  a  suitable  meal-room,  unless  the  works  are  closed 

during  meal  hours  ; 

(b)  a  suitable  place  or  places  for  clothing  put  off  during 

working  hours  ;  and 

(c)  a  suitable  place  or  places  for  the  storage  of  overalls 

provided  in  pursuance  of  Regulation  8  ;  which 
place  or  places  shall  be  separate  from  those 
required  by  paragraphs  (a)  and  (b)  of  this 
Regulation  ; 

all  of  which  shall  be  so  located  as  not  to  be  exposed  to  dust 

or  fumes  from  any  manufacturing  process. 

12.  There  shall  be  provided  and  maintained  in  a  cleanly 
state  and  in  good  repair  for  the  use  of  all  persons  employed 
in  any  lead  process  : — 

(a)  a  lavatory,  under  cover,  with  a  sufficient  supply  of 
clean  towels,  renewed  daily,  and  of  soap  and  nail 
brushes,  and  with  either  : — 

(i.)  a  trough  with  a  smooth  impervious  sur- 
face, fitted  with  a  waste-pipe  without  plug,  and 
of  such  length  as  to  allow  at  least  two  feet  for 
every  five  such  persons  employed  at  any  one 
time,  and  having  a  constant  supply  of  warm 
water  from  taps  or  jets  above  the  trough  at 
intervals  of  not  more  than  two  feet ;  or 

(ii.)  at  least  one  lavatory  basin  for  every  five 
such  persons  employed  at  any  one  time,  fitted 
with  a  waste-pipe  and  plug,  and  having  either  a 
constant  supply  of  hot  and  cold  water  or  warm 


246  LEAD  POISONING 

water  laid  on,  or  (if  a  constant  supply  of  heated 
water  be  not  reasonably  practicable)  a  constant 
supply  of  cold  water  laid  on,  and  a  supply  of  hot 
water  always  at  hand  when  required  for  use  by 
such  persons  ;  and 
{b)  sufficient  and  suitable  bath  accommodation  (douche 
or  other)  with  hot  water  laid  on,  unless  the  water 
supply  provided  under  paragraph  (a)  is  so 
arranged  that  a  warm  douche  for  the  face,  neck 
and  arms  can  be  taken. 

Provided  that,  when  the  number  of  persons  so  employed 
at  any  one  time  is  temporarily  increased  by  reason  of  Hue 
cleaning,  it  shall  not  be  necessary  to  provide  (by  reason 
only  of  such  temporary  increase)  additional  accommodation 
in  pursuance  of  paragraph  (a)  of  this  Regulation  if  adequate 
time  is  allowed  to  all  such  persons  for  washing  immediately 
before  each  meal  (in  addition  to  the  regular  meal  times), 
and  immediately  before  the  end  of  the  day's  work. 

13.  (a)  Every  person  employed  in  a  lead  process  shall  be 
examined  by  the  Surgeon  once  in  every  calendar  month  (or 
at  such  shorter  or  longer  intervals  as  may  be  prescribed  in 
writing  by  the  Chief  Inspector  of  Factories)  on  a  date  of 
which  due  notice  shall  be  given. 

(b)  A  Health  Register  containing  the  names  of  all  persons 
employed  in  any  lead  process  shall  be  kept  in  a  form 
approved  by  the  Chief  Inspector  of  Factories. 

(c)  No  person  after  suspension  shall  be  employed  in  any 
lead  process  without  written  sanction  from  the  Surgeon, 
entered  in  the  Health  Register. 

Part  II. — Duties  of  Persons  Employed. 

14.  (a)  Every  person  employed  in  any  lead  process  shall 
deposit  in  the  place  or  places  provided  in  pursuance  of 
Regulation  1 1  (b)  all  clothing  put  off  during  working  hours. 

(b)  Every  person  for  whose  use  an  overall  is  provided  in 
pursuance  of  Regulation  8  shall  wear  the  overall  when 
employed  in  any  process  named  in  that  Regulation,  and 


FACTORY  AND  WORKSHOP  ORDERS        247 

remove  it  before  partaking  of  food  or  leaving  the  premises, 
and  deposit  it  in  the  place  provided  under  Regulation  11  (c). 
(c)  Every  person  for  whose  use  a  respirator  is  provided  in 
pursuance  of  Regulation  9,  shall  wear  the  respirator  while 
employed  in  any  process  to  which  Regulation  2  (2)  or 
Regulation  8  applies. 

15.  No  person  employed  shall  introduce,  keep,  prepare, 
or  partake  of  any  food  or  drink  (other  than  a  non-alcoholic 
drink  approved  by  the  Surgeon),  or  make  use  of  tobacco, 
in  any  place  in  which  any  lead  process  is  carried  on  ; 

Provided  that,  except  in  processes  named  in  Regulation  8, 
this  Regulation  shall  not  prevent  any  person  from  using 
tobacco,  other  than  a  cigar  or  cigarette,  if  his  hands  are 
free  from  lead. 

16.  Every  person  employed  in  any  lead  process,  or  in  any- 
place where  any  lead  process  is  being  carried  on,  shall, 
before  partaking  of  food,  wash  the  face  and  hands,  and 
before  leaving  the  premises,  wash  the  face,  neck,  and  arms, 
in  the  lavatory  provided  in  pursuance  of  Regulation  12. 

17.  Every  person  employed  in  any  lead  process  shall 
present  himself  at  the  appointed  time  for  examination  by 
the  Surgeon,  in  pursuance  of  Regulation  13  (a). 

18.  No  person  employed  shall,  after  suspension  under 
these  Regulations,  or  under  any  other  Regulations  or 
Special  Rules  applying  to  factories  or  workshops  where 
any  process  involving  the  use  of  lead  is  carried  on,  work 
in  any  lead  process  without  written  sanction  from  the 
Surgeon  entered  in  the  Health  Register. 

19.  No  person  employed  shall  interfere  in  any  way, 
without  the  concurrence  of  the  occupier  or  manager,  with 
the  means  provided  for  the  removal  of  gas,  vapour,  fumes, 
and  dust,  and  for  the  carrying  out  of  these  Regulations. 

W.  S.  Churchill, 
One  of  His  Majesty's  Principal 
Secretaries  of  State 
Home  Office,  Whitehall, 
August  12,  1911. 


248  LEAD  POISONING 

For  the  Manufacture  and  Decoration  of  Pottery.'5' 
1913.    No.  2. 

In  pursuance  of  Section  79  of  the  Factory  and  Workshop 
Act,  1901,1  I  hereby  make  the  following  Regulations,  and 
direct  that  they  shall  apply  to  all  factories  and  workshops 
in  which  the  manufacture  or  decoration  of  pottery  or  any 
process  incidental  thereto  is  carried  on  ;  including  factories 
and  workshops  in  which  lithographic  transfers,  frits,  or 
glazes  are  made  for  use  in  the  manufacture  or  decoration 
of  pottery. 

Provided  that,  if  at  any  time  it  is  shown  to  the  satisfac- 
tion of  the  Secretary  of  State  in  the  case  of  any  manufac- 
ture or  process  or  any  operation  forming  part  thereof,  that 
injury  to  health  is  adequately  prevented  byother  appliances 
or  under  other  conditions  than  those  prescribed  by  these 
Regulations,  he  may,  by  Order,  modify  the  whole  or  any 
part  of  the  Regulations,  so  far  as  they  apply  to  such 
manufacture  or  process.  Any  such  Order  may  be  revoked, 
modified,  or  extended  by  further  Order. 

And  provided,  further,  in  regard  to  Regulation  10  (a),  the 
Secretary  of  State  may,  by  Order — 

(i.)  grant  exemptions  from  this  Regulation  in  the  case 
of  any  special  branch  of  the  industry  if  it  can  be 
shown  that  every  means  has  been  tried  for  the 
purpose  of  conforming  to  the  prescribed  limit ; 
(ii.)  substitute  a  limit  higher  than  700  Fahrenheit  in  the 
case  of  printing  or  other  specified  shops,  if  it 
can  be  shown  to  be  necessary. 

Definitions.% 
In  these  Regulations  : 

"  Pottery  "  includes  earthenware,  china,  tiles,  and  any 
other  articles  made  from  clay,  with  or  without 
the  addition  of  other  material. 

*  These  Regulations  were  gazetted  January  7,  191 3. 
t  1  Edw.  7,  c.  22. 

X  Terms  to  which  defined  meanings  are  given  are  printed 
throughout  in  italics. 


FACTORY  AND  WORKSHOP  ORDERS        249 

"  Coarse  ware"  means  pottery  not  shaped  by  compres- 
sion of  powdered  material,  and  not  fired  more 
than  once  in  the  process  of  manufacture. 

In  the  case  of  a  fireclay  works  in  which 
the  ware  is  generally  fired  only  once,  the 
whole  of  the  works  may,  with  the  approval  in 
writing  of  the  Chief  Inspector  of  Factories,  be 
regarded  as  a  coarse  ware  factory,  notwithstand- 
ing that  some  of  the  clay  ware  is  hardened  by 
fire  before  any  slip  or  body  coating  is  applied 
to  the  fireclay  body ;  subject,  however,  to  the 
following  conditions  : 

(i.)  no  slip  or  body  coating  shall  be  applied 

before  such  hardening ; 
(ii.)  neither  the  ware  so   hardened   nor   any 
subsequently  applied  slip  or  body  coat- 
ing shall  be  sandpapered  or  treated  by 
any  other  process  which  would  generate 
dust  ; 
(iii.)  the  approval  of  the  Chief  Inspector  of 
Factories  shall  be  kept  attached  to  the 
general  register,  and  shall  be  subject  to 
the  further  conditions,  if  any,  specified 
therein,    and    shall    be   revocable    by 
further  notice  in  writing. 
"  Leadless  glaze  "  means  a  glaze  which  does  not  contain 
more  than  one  per  cent,  of  its  dry  weight  of  a  lead 
compound  calculated  as  lead  monoxide. 
"  Low  solubility  glaze  "  means 

(1)  a  glaze  which   does  not  yield   to   dilute 

hydrochloric  acid  more  than  five  per 
cent,  of  its  dry  weight  of  a  soluble  lead 
compound  calculated  as  lead  monoxide 
when  determined  in  the  manner  de- 
scribed below  ;  or 

(2)  a  glaze  containing  no  lead  or  lead  com- 

pound other  than  galena. 


250  LEAD  POISONING 

A  weighed  quantity  of  dried  material 
is  to  be  continuously  shaken  for  one 
hour,  at  the  common  temperature,  with 
i, coo  times   its  weight  of  an  aqueous 
solution  of  hydrochloric  acid  contain- 
ing C25  per  cent,  of  HC1.     This  solu- 
tion is  thereafter  to  be  allowed  to  stand 
for  one  hour,  and  to  be  passed  through 
a  filter.     The  lead  salt  contained  in  an 
aliquot  portion  of  the  clear  filtrate  is 
then  to  be  precipitated  as  lead  sulphide, 
and  weighed  as  lead  sulphate. 
"  Galena "   means   the   native   sulphide  of    lead   con- 
taining not  more  than  five  per  cent,  of  a  soluble 
lead   compound    calculated   as   lead   monoxide 
when  determined  in  the  manner  described  in 
the  definition  of   low  solubility  glaze.     Galena 
shall  not  for  the  purpose  of  these  Regulations 
be  deemed  to  be  an  unfritted  lead  compound. 
" Leadless  glaze  factory"  means  a  factory  the  occupier 
of  which  has  given  an  undertaking,  to  the  satis- 
faction of  the  Chief  Inspector  of  Factories,  that 
none  but  leadless  glaze  shall  be  used  therein,  and 
in  which  none  but  leadless  glaze  is  in  fact  used. 
"Low  solubility  glaze  factory  "   means   a  factory  the 
occupier  of  which   has   given  an  undertaking, 
to  the  satisfaction   of   the   Chief   Inspector   of 
Factories,  that  none  but  low  solubility  glaze  shall 
be   used   therein,    and   in  which  none  but  low 
solubility  glaze  is  in  fact  used. 
"Majolica  painting"  includes  painting  in  majolica  or 

other  glaze. 
"  Surgeon "  means  the  Certifying  Factory  Surgeon  of 
the  district,  who  shall  have,  as  regards  all 
persons  examined  by  him  in  pursuance  of  these 
Regulations,  power  of  suspension  and  of  permis- 
sion to  work,  by  certificate  which  may  either  be 


FACTORY  AND  WORKSHOP  ORDERS        251 

entered    in   the  health  register  by   the  Surgeon 
personally,  or  be  sent  by  him  to  the  occupier. 
"  Entered  in  the  health  register  "  means — 

(a)  Entered  in  the  prescribed  register  kept  at 

the  factory    in   pursuance   of   Regula- 
tion 3  ;  or 

(b)  Entered    in    the    portable    register    pre- 

scribed for  the  use  of  casual  workers. 
"  Suspension  "  means  suspension,  by  signed  certificate  of 

the  Surgeon,  from  employment  in  any  process  in 

which  examination  by  the  Surgeon  is  required  by 

these  Regulations. 
"Permission   to  work"    means   permission,  by   signed 

certificate  of  the  Surgeon,  either — 

(a)  Terminating  a  suspension,  or 

(b)  Permitting  employment  of  a  certain  speci- 

fied kind. 

"  Potter's  shops  "  includes  any  place  where  tiles  or  other 
articles  are  made  by  pressing  clay  dust,  as  well 
as  every  place  where  articles  of  pottery  are 
shaped  by  a  plastic  or  other  process. 

"  Wedging  of  clay  "  means  the  treatment  of  clay  which 
has  not  been  pugged  or  rolled,  by  raising  one 
piece  of  clay  by  hand  and  bringing  it  down  upon 
another  piece  ;  but  does  not  include  the  process, 
frequently  known  as  "  slapping  of  clay,"  in  which 
two  pieces  of  clay,  each  small  enough  to  be  held 
in  one  hand,  are  slapped  together. 

"  Workroom  "  shall  not,  for  the  purposes  of  Regula- 
tion 10,  include  any  stove  or  drying  chamber 
which  is  not  entered  by  workers  except  for 
the  purpose  of  carrying  ware  in  or  out  or 
turning  it. 
"  Bedding"  means  the  placing  of  flat  ware  in  powdered 
flint  for  the  biscuit  firing  when  the  sagger  or 
box  containing  the  ware  is  filled  up  with 
powdered  flint. 


252  LEAD  POISONING 

"  Flinting"  means  the  placing  of  flat  ware  in  powdered 
flint  for  the  biscuit  firing  when  the  sagger  or 
box  containing  the  ware  is  not  filled  up  with 
powdered  flint. 

"  Scouring  "  includes  fine  brushing,  as  well  as  sand- 
papering, brushing,  and  every  other"  scouring 
process,  as  applied  to  biscuit  ware. 

"  Stopping  of  biscuit  ware "  means  the  filling  up  of 
cracks  in  ware  which  has  been  fired  once  and 
before  glaze  is  applied  to  it. 

"  Glost  placing "  includes  the  operations  of  carrying 
saggers  of  ware  into  the  glost  oven  and  carrying 
them  out  again  after  the  glost  firing,  as  well  as 
the  operation  of  placing  the  ware  in  the  saggers 
for  glost  firing  ;  but  not  placing  of  ware  on 
cranks  or  similar  articles  prior  to  their  transfer 
to  saggers  or  kilns  by  other  persons. 

''Flow  material"  means  any  material  containing  lead, 
which  is  placed  in  saggers,  with  a  view  to  its 
entire  or  partial  volatilization  during  the  glost 
firing  of  the  ware. 

"  Thimble  picking"  means  the  picking  over,  sorting,  or 
rearranging  for  further  use,  of  thimbles,  stilts, 
spurs,  strips,  saddles,  or  any  similar  articles 
which  have  been  used  for  the  support  of  articles 
of  pottery  during  the  process  of  glost  firing. 

"Efficient  exhaust  draught"  used  in  connection  with  a 
process  means  an  exhaust  draught  which  effectu- 
ally removes,  as  near  as  possible  to  the  point  of 
origin,  the  dust  generated  in  the  process.  No 
draught  shall  be  deemed  to  be  efficient  which 
fails  effectually  to  remove  smoke  generated  at 
any  point  where  dust  originates  in  the  process. 


FACTORY  AND  WORKSHOP  ORDERS        253 

Part  I. — Duties  of  Occupiers. 

1.  Age  and  Sex. 

(a)  No  women,  young  person,  or  child  shall  be  employed 
in  the  following  processes  : 

X  (i.)  Stopping  of  biscuit  ware  with  a  material  which 
yields  to  dilute  hydrochloric  acid  more  than  five 
per  cent,  of  its  dry  weight  of  a  soluble  lead 
compound  calculated  as  lead  monoxide  when 
determined  in  the  manner  described  in  the 
definition  of  low  solubility  glaze ; 

*  (ii.)  weighing  out,  shovelling,  or  mixing  of  unfritted 

lead  compounds   in  the  preparation  or   manu- 
facture of  frits,  glazes,  or  colours  ; 
*f  (iii.)  lawning   of  glaze,  except   where   less   than  a 
quart  of  glaze  is  lawned  at  a  time  for  the  worker's 
own  use ; 
J  (iv.)  preparation  or  weighing  out  of  flow  material, 
(*)  (+)  (v0  cleaning,  as  prescribed  in  Regulation  12,  of 
floors  of  potters'  shops  or  stoves  or  any  place  in 
which  any  process  included  in  the  Schedule  is 
carried  on  ; 

*  (vi.)  cleaning,   as   prescribed  in    Regulation    17,    of 

boards  used  in  the  dipping  house,  dipper's 
drying  room,  ware  cleaning  room,  or  glost 
placing  shop  ; 

*X  (vii.)  cleaning  of  mangles  or  any  part  thereof  ; 

%  (viii.)  washing  of  saggers  with  a  wash  which  yields 
to  dilute  hydrochloric  acid  more  than  five  per 
cent,  of  its  dry  weight  of  a  soluble  lead  com- 

*  The  Regulations  in  question  are  marked  *  ;  or  in  case  of 
partial  or  conditional  exemption  (*). 

f  The  Regulations  in  question  are  marked  f  ;  or  in  the  case 
of  partial  or  conditional  exemption  (t). 

%  The  Regulations  in  question  are  marked  J ;  or  in  case  of 
partial  or  conditional  exemption  (\). 


254  LEAD  POISONING 

pound  calculated  as  lead  monoxide  when  deter- 
mined in  the  manner  described  in  the  definition 
of  low  solubility  glaze. 

(b)  No  young  person  or  child,  other  than  a  male  young 
person  who  wedges  clay  only  for  his  own  use,  shall  be 
employed  in  the  wedging  of  clay;  and  no  woman  shall 
be  so  employed  without  a  certificate  of  permission  to  work. 

(c)  No  young  person  or  child  shall  be  employed  in  the 
carrying  of  clay,  or  other  systematic  carrying  or  lifting 
work,  without  a  certificate  of  permission  to  work,  specifying 
the  maximum  weight  which  he  or  she  may  carry  ;  and  no 
young  person  or  child  so  employed  shall  be  allowed  to  lift 
or  carry  any  weight  in  excess  of  that  named  in  the  certifi- 
cate.    Provided  that : — 

(i.)  No  certificate  shall  permit  the  carrying  of  more 
than  30  lb.  by  anyone  under  16  years  of  age ; 
and 

(ii.)  No  girl  under  16  years  of  age  and  no  boy  under  15 
years  of  age  shall  be  allowed  to  carry  clay, 
except  that  such  a  worker  who  is  working  for 
himself  or  herself,  and  is  not  an  attendant  of 
another  worker,  shall  be  allowed  to  carry  such 
clay  as  is  to  be  used  by  himself  or  herself  in 
making  articles  of  pottery. 

(d)  No  female  shall  be  employed  for  more  than  seven 
days  as  a  wheel-turner  for  a  thrower,  without  a  certificate 
of  permission  to  work. 

(e)  No  girl  under  16  years  of  age  shall  be  employed  as  a 
lathe  treader. 

*t  (/)  No  young  person  or  child  shall  be  employed  as  a 
dipper. 

*t  (g)  No  girl  under  17  years  of  age  and  no  boy  under 
16  years  of  age  shall  be  employed  as  a  dipper's  assistant  or 
ware  cleaner. 

*t  (//)  No  woman,  young  person,  or  child  shall  be 
employed  as  a  glost  placer,  except  in  the  placing  of  china 
furniture  or  electrical  fittings ;  and  no  girl  under  17  years 


FACTORY  AND  WORKSHOP  ORDERS        255 

of  age  and  no  boy  under  16  years  of  age  shall  be  employed 
as  a  glost  placer  in  the  placing  of  china  furniture  or 
electrical  fittings.  Except  that  male  young  persons  over 
16  years  of  age  may  be  employed  in  the  process  of  glost 
placing  for  the  purpose  of  preparing  saggers  and  assisting 
in  the  sagger-house  during  the  drawing  of  ovens,  provided 
that  they  shall  not  place  any  ware  in  the  saggers. 

*(k)  In  low  solubility  glaze  factories  : — 

(i.)  No  person  under  16  years  of  age  shall  be  employed 

as  a  dipper  ; 
(ii.)  No  person  under  15  years  of  age  shall  be  employed 

as   a   dipper's   assistant,   ware  cleaner,  or  glost 

placer. 

(*)  (J)  (0  Except  as  provided  in  Regulation  1  (k)  (ii.)  no 
person  under  16  years  of  age  shall  be  employed  in  any 
process  included  in  Part  I.  of  the  Schedule  ;  and  no  person 
under  15  years  of  age  shall  be  employed  in  any  process  in- 
cluded in  Part  II.  of  the  Schedule. 

(w)  No  female  shall  carry  a  sagger  full  of  ware  ;  but 

(i.)  the  moving  of  such  a  sagger  from  one  part  of  a 
bench  to  a  contiguous  part  of  the  same  bench  on 
the  same  level ;  or 
(ii.)  the  moving  of  such  a  sagger  by  any  two  females 
from  a  bench  to   the  nearest  convenient  floor 
space  in  the  same  workroom  if  no  saggers  so 
moved  are  piled  to  a  greater  height  than  four 
feet, 
shall  not  be  deemed  to  be  a  contravention  of  this  require- 
ment. 

2.  Periodical  Examinations. 

(*)  (t)  (+)  (a)  All  persons  employed  in  any  process 
included  in  Part  I.  of  the  Schedule  shall  be  examined  once 
in  each  calendar  month  by  the  Surgeon  ;  and  all  persons 
employed  in  any  process  included  in  Part  II.  of  the 
Schedule  shall  be  examined  once  in  every  twelve  months 
by  the  Surgeon. 


256  LEAD  POISONING 

(b)  All  persons  for  whom  certificates  of  permission  to  work 
are  required  by  Regulation  i  shall  be  examined  by  the 
Surgeon  within  seven  days  of  the  commencement  of  their 
employment  in  a  process  in  which  such  a  certificate  is 
required. 

(c)  All  young  persons  and  children  employed  in  the 
carrying  of  clay,  or  other  systematic  carrying  or  lifting 
work,  shall  be  re-examined  by  the  Surgeon  twice  in  the  first 
period  of  six  months,  and  once  in  each  period  of  six 
months  thereafter  until  they  attain  the  age  of  18. 

(d)  Any  female  examined  for  employment  as  a  wheel- 
turner  shall  be  presented  for  re-examination  at  a  later  date, 
if  the  Surgeon  considers  it  necessary. 

(*)  (t)  (X)  ' e)  The  fees  for  all  medical  examinations 
made  in  pursuance  of  these  Regulations  shall  be  paid  by  the 
employer  and  shall  not  be  charged  to  the  worker,  whether 
he  be  in  regular  or  casual  employment.  Provided  that 
casual  workers  examined  at  the  Surgeon's  surgery  shall  pay 
a  fee  of  one  shilling  for  each  certificate  entered  in  the 
portable  register  ;  this  fee  shall  be  refunded  by  the 
occupier  who  first  employs  the  worker  after  such  examina- 
tion ;  and  the  occupier  shall  record  in  the  portable  register 
the  fact  that  the  fee  has  been  refunded. 

(*)  (t)  ■(+)  (/)  A  notice  shall  be  affixed  in  a  prominent 
place  in  the  factory,  showing  clearly  the  time  appointed  for 
the.  Surgeon's  periodical  visit  ;  and  an  amending  notice 
shall  be  affixed  forthwith  if  it  is  found  necessary  to  alter 
the  date  or  hour ;  wherever  possible,  not  less  than  three 
days'  notice  of  a  change  of  date  shall  be  given. 

(*)  (t)  (+)  (§)  A  private  room  shall  be  provided  for  all 
medical  examinations.  No  one  shall  be  present  except 
such  other  medical  man  as  the  Surgeon  may  with  the 
worker's  consent  admit  ;  and  in  addition  in  the  case  of  a 
female  any  one  female  relative  may  be  present,  or  alterna- 
tively any  one  workwoman  in  the  factory  approved  by  the 
worker  and  the  Surgeon. 

(*)  (t)  (+)  (h)  No  person  after  suspension  shall  be  allowed 
to  work  in  any  process  in  which  examination  by  the  Surgeon 


FACTORY  AND  WORKSHOP  ORDERS        25; 

is  required  by  these  Regulations,  without  a  certificate   of 

permission  to  work. 

3.  Health,  etc.,  Register. 

(*)  (+)  (|)  (a)  A  register,  in  the  form  or  forms  prescribed, 
shall  be  kept,  in  which  the  Surgeon  ma}'  enter  the  dates  and 
results  of  his  visits,  the  number  of  persons  examined  in 
pursuance  of  these  Regulations,  and  particulars  of  any 
directions  given  by  him.  This  register  shall  contain  a 
correct  list  of  all  persons  emplo3red  in  the  processes  included 
in  the  Schedule,  and  of  all  persons  for  whom  a  certificate 
has  been  obtained  in  pursuance  of  Regulation  1  ;  as  well  as 
all  other  particulars  required  to  be  entered  in  the  register 
in  pursuance  of  these  Regulations. 

(*)  (t)  (|)  (6)  The  register  shall  be  open  to  the  inspec- 
tion of  any  worker  so  far  as  concerns  the  entries  relating  to 
that  worker.  All  such  entries  as  indicate  the  general 
health  of  the  worker  shall  be  so  expressed  as  to  be  readily 
understood  both  by  occupiers  and  persons  employed. 

{*)  (+)  (±)  (c)  When  a  certificate  of  suspension  or  permis- 
sion to  work  is  sent  by  the  Surgeon  to  the  occupier,  it  shall 
be  forthwith  attached  to  the  register,  and  shall  be  kept  so 
attached  until  replaced  by  a  personal  entry  by  the  Surgeon 
in  the  register. 

4.  Overalls  and  Head-Coverings. 

(*)  (±)  (a)  The  occupier  shall  provide  and  maintain 
suitable  overalls  and  head-coverings  for  all  persons 
employed  in  the  processes  included  in  the  Schedule  ; 
except  that  head-coverings  need  not  be  provided  for 
persons  employed  in  majolica  painting  or  glost  placing. 

(*)  (+)  (b)  Head-coverings  shall  be  adequate  to  protect 
the  hair  from  dust,  and  shall  be  worn  in  such  a  manner  as 
to  be  effective  for  this  purpose. 

(*)  (c)  The  occupier  shall  provide  and  maintain  suitable 
aprons  of  a  waterproof  or  similar  material  which  can  be 
sponged  daily,  for  all  dippers,  dippers'  assistants,  and  ware 

17 


258  LEAD  POISONING 

cleaners  ;  provided  that,  if  the  front  of  the  overall  supplied 
to  any  such  worker  in  pursuance  of  these  Regulations  is 
made  of  a  material  which  can  be  sponged  daily,  no  separate 
apron  need  be  provided  for  that  worker. 

(*)  (+)  (d)  No  person  shall  be  allowed  to  work  in  any 
process  included  in  the  Schedule  without  wearing  the 
above-named  overalls  and  head-coverings,  as  well  as  aprons 
when  provided  in  pursuance  of  the  preceding  paragraph  ; 
except  that  head-coverings  need  not  be  worn  by  persons 
employed  in  majolica  painting  or  glosf  placing. 

(*)  (e)  All  aprons  made  of  waterproof  or  similar  material, 
and  all  overalls  or  parts  of  overalls  made  of  such  material, 
shall  be  thoroughly  cleaned  daily  by  the  wearers  by 
sponging  or  other  wet  process.  All  other  overalls  or  parts 
of  overalls  and  all  head-coverings  shall  be  washed  or 
renewed  at  least  once  a  week  ;  and  the  occupier  shall  pro- 
vide for  washing,  renewal,  and  necessary  repairs  of  all 
overalls  and  head-coverings  to  be  done  either  at  the  factory 
or  at  a  laundry  ;  and  no  worker  shall  be  allowed  to  take 
home  any  overalls,  head-coverings,  or  aprons  provided  in 
pursuance  of  these  Regulations. 

(*)  (+)  00  All  overalls,  head-coverings,  and  aprons 
provided  in  pursuance  of  these  Regulations,  when  not  in 
use  or  being  washed  and  repaired,  shall  be  kept  in  proper 
custody ;  for  this  purpose  there  shall  be  provided  a 
cupboard  or  cupboards  or  room  or  rooms  suitably  situated 
and  sufficiently  large  to  hold  the  overalls,  head-coverings, 
and  aprons  ;  a  separate  peg  shall  be  provided  for  each 
Worker  who  is  required  by  these  Regulations  to  wear 
overalls. 

6.  Food. 

(.*)  (J)  (a)  No  person  shall  be  allowed  to  keep,  or  pre- 
pare, or  partake  of  any  food,  drink,  or  tobacco,  or  to 
remain  during  meal-times  in  any  place  in  which  is  carried 
on  any  process  included  in  the  Schedule,  or  the  process  of 
towing,  or  the  process  of  tile-making  by  the  compression  of 
dust,  or  any  other  process  which  the  Inspector  of  Factories 


FACTORY  AND  WORKSHOP  ORDERS        259 

for  the  district  shall  certify  as  sufficiently  dusty  to  render 
the  room  in  which  it  is  carried  on  an  unsuitable  place,  in 
his  opinion,  for  persons  to  remain  during  meal-times. 

(*)  (J)  {b)  Mess-room  accommodation  shall  be  provided 
for  the  workers  employed  in  the  processes  included  in  the 
Schedule,  and  for  such  others  as  are  excluded  from  their 
own  workrooms  during  meal-times  in  pursuance  of  para- 
graph (a)  of  this  Regulation. 

(*)  (;)  (c)  This  accommodation  shall  consist  of  a  clean, 
well-ventilated,  and  well-lighted  room  or  rooms  in  which  no 
manufacturing  process  is  carried  on ;  it  shall  be  at  or 
near  the  factory,  and  shall  be  sufficiently  large  to  accom- 
modate all  the  workers  employed  in  the  processes  included 
in  the  Schedule  and  all  others  who  are  excluded  from  their 
own  workrooms  during  meal-times  in  pursuance  of  para- 
graph (a)  of  this  Regulation,  allowing  floor  space  in  accord- 
ance with  the  following  scale  : — 

In  mess-rooms  for — 

6  persons  and  under         it»i  sq.  ft.  per  person. 

Over  6  persons  and  up  to  12      ...       7^       „  „ 

„     12         „  „  20       ...       6 

>,     20        „  „  28       ...       si       „ 

,,     28         „  ,,     any  number     5         „  ,, 

(*)  (±)  (d)  Provided  that  if  the  Inspector  of  Factories  for 
the  district  shall  certify  that  in  his  opinion  the  special 
circumstances  of  any  factory  are  such  as  to  render  the 
provision  of  mess-room  accommodation  for  all  such  workers 
unnecessary,  it  shall  be  sufficient  to  provide  accommoda- 
tion, calculated  on  the  above  scale,  for  such  a  proportion  of 
all  such  workers  as  is  named  on  the  certificate  of  the 
Inspector;  but  in  no  case  shall  this  proportion  be  less  than 
one-third,  subject,  in  cases  of  difficulty,  to  appeal  to 
H.M.  Chief  Inspector  of  Factories  ;  and  the  Inspector  for 
the  district  shall  have  the  right,  at  any  time,  to  cancel  or 
amend  any  such  certificate. 

(*)   (+)   (e)  All  mess-rooms  provided  in  pursuance  of  this 


260  LEAD  POISONING 

Regulation  shall  be  furnished  with  proper  tables  and 
seats  ;  provision  shall  be  made  for  maintaining  a  proper 
temperature  not  below  55  degrees  Fahrenheit ;  and  all 
mess-rooms  shall  be  thoroughly  cleaned  daily  at  the 
occupier's  expense. 

(*)  (|)  (/)  No  person  shall  be  allowed  to  take  into  a 
mess-room  any  overall,  head-covering,  or  apron,  worn  in  a 
process  included  in  the  Schedule. 

0  (t)  (i)  The  washing  conveniences  prescribed  by  the 
Regulations  shall  not  be  maintained  in  any  mess-room. 

(*)  (!)  V1)  A  suitable  place  for  the  deposit  of  food  shall 
be  provided  for  each  worker  using  the  mess-room.  Such 
provision  shall  not  be  made  in  a  room  in  which  any 
manufacturing  process  is  carried  on,  and  shall  be  subject  in 
each  case  to  the  approval  of  the  Inspector  of  Factories  for 
the  district. 

(*)  (J)  (^')  Adequate  facilities  shall  be  provided  to  enable 
workpeople  to  heat  their  food. 

(*)  (!)  (0  A  supply  of  milk,  or  cocoa  made  with  milk, 
shall  be  provided  for  all  women  and  young  persons  work- 
ing in  processes  included  in  Part  I.  of  the  Schedule,  who 
commence  work  before  9  a.m.  Not  less  than  half  a  pint 
shall  be  provided  for  each  such  worker  at  the  expense  of 
the  occupier. 

7.    Suppression  of  Dust. 

(a)  The  following  processes  shall  not  be  carried  on 
without  the  use  of  an  efficient  exhaust  draught  : — 

J  (i.)  The  fettling  of  flat  ware,  whether  china  or 
earthenware,  by  towing  or  sandpapering,  pro- 
vided that  this  shall  not  apply  to  the  occasional 
finishing  of  pieces  of  china  or  earthenware 
without  the  aid  of  mechanical  power  ; 

J  (ii.)  The  sand-sticking  of  sanitary  ware  ; 

%  (iii.)  Any  other  process  of  fettling  on  a  wheel  driven 
by  mechanical  power,  except  where  : 


FACTORY  AND   WORKSHOP  ORDERS        261 

(a)  The  fettler  is    fettling,    as   an    occasional 

operation,  only  ware  of  his  or  her  own 
making ;  or 

(b)  The  fettling   is  done  wholly  with   a  wet 

sponge  or  other  moist  material  ;  or 

(c)  The  fettling  is  done  by  the  worker  who  has 

made  the  articles,  whilst  the  latter  are 
still  in  a  moist  state. 
i  (iv.)  The  sifting  of    clay  dust  for   making   tiles  or 
other  articles  by  pressure,  except  where  : 

(a)  This  is  done  in  a  machine  so  enclosed  as 

effectually   to    prevent    the    escape    of 
dust  ;  or 

(b)  The  material  to  be  sifted  is  so  damp  that 

no  dust  can  be  given  off. 
t  (v.)  The  pressing  of  tiles  from  clay  dust,  an  exhaust 
opening  being  connected  with  each  press  ;  this 
clause  shall  also  apply  to  the  pressing  from  clay 
dust   of    articles    other    than    tiles,    unless    the 
material  is  so  damp  that  no  dust  is  given  off. 
t  ivi.)  The  fettling  of  tiles  made  from  clay  dust  by 
pressure,    exxept   where    the    fettling    is    done 
wholly  on  or  with  damp  material  ;  this  clause 
shall  also  apply  to  the  fettling  of  other  articles 
made  from  clay  dust,  unless  the  material  is  so 
damp  that  no  dust  is  given  off. 
i  (vii.)  The  processes  of  bedding  and  flinting. 
J  (viii.)  The  brushing  of  earthenware  biscuit,  unless  the 
process  is  carried  on  in  a  room  provided  with 
efficient    general    mechanical    ventilation    or 
other   ventilation   which   is    certified    by   the 
Inspector    of    Factories    for   the    district    as 
adequate,    having  regard   to   all   the    circum- 
stances of  the  case. 
%  (ix.)  Scouring  of  biscuit  ware  which  has  been  fired  in 
powdered  flint,  except  where  this  is  done  in 
machines  so  enclosed  as  effectually  to  prevent 
the  escape  of  dust. 


262  LEAD  POISONING 

X  (x.)  Batting  of  biscuit  ware  which  has  been  fired  in 

powdered  flint. 
X  (xi.)  Glaze  blowing. 

0  f  (x"- )  Ware  cleaning  after  the  application  of  glaze 

by  dipping  or  other  process,  except  as  set  forth 
later  in  this  Regulation. 

1  (xiii.)    The    preparation    of    weighing    out   of   flow 

material  which  yields  to  dilute  hydrochloric 
acid  more  than  five  per  cent,  of  its  dry  weight 
of  a  soluble  lead  compound  calculated  as  lead 
monoxide   when   determined   in   the  manner 
described   in   the   definition  of   low  solubility 
glaze. 
|  (xiv.)  The  lawning  of  dry  colours,  except  where  not 
more  than  an  ounce  at  a  time  is  lawned  for  use 
in  painting. 
X  (xv.)  Ground    laying,    including   the   wiping   off   of 
colour  after  its  application  to  the  surface  of 
the  ware. 
X  (xvi.)  Colour   dusting,    whether  under-glaze    or  on- 
glaze,  including  the  wiping  off  of  colour  after 
its  application  to  the  surface  of  the  ware. 
|  (xvii.)  Colour    blowing    or    aerographing,    whether 
under-glaze  or  on-glaze,  including  the  wiping 
off   of    colour    after    its    application    to    the 
surface  of  the  ware. 
|  (xviii.)  The    making   of    lithographic   transfers,   in- 
cluding  the   wiping   off   of    colour    after   its 
application   to   the    surface    of    the    transfer 
sheets. 
(b)  In  the  process  of  mould-making,  every  bin  or  similar 
receptacle   used   for    holding    plaster    of    Paris    shall    be 
provided  with  an  efficient  exhaust  draught  so  arranged  as  to 
prevent  the  escape  of  plaster  of  Paris  dust  into  the  air  of 
the  workplace  ;  except  where  a  cover  is  provided  for  the 
bin  or  other  receptacle,  and  the  plaster  of  Paris  is  conveyed 
in  a  sack,  the  mouth  of  which  is  tied  and  only  loosened 
after  it  has  been  placed  in  the  bin  or  other  receptacle. 


FACTORY  AND  WORKSHOP  ORDERS       263 

(c)  The  dry  grinding  of  materials  for  pottery  bodies  shall 
be  done  either  with  an  efficient  exhaust  draught  for  the 
removal  of  dust,  or  in  machines  so  enclosed  as  effectually 
to  prevent  the  escape  of  dust ;  except  that  it  shall  not  be 
deemed  necessary  in  pursuance  of  this  Regulation  to 
provide  an  exhaust  draught  to  remove  small  amounts  of 
dust  given  off  at  the  hopper  of  an  enclosed  machine  in  the 
course  of  feeding  the  same,  if  an  outlet  into  an  exhaust  duct 
or  to  the  outside  air  is  fitted  to  the  receptacle  into  which 
the  powdered  material  is  delivered. 

(d)  In  the  process  of  sand-sticking  of  sanitary  ware,  suit- 
able provision  shall  be  made  for  collecting  any  material 
which  falls  on  the  floor. 

I  (e)  In  the  process  of  making  tiles  from  clay  dust  by 
pressure,  supplies  of  material  shall  be  conveyed  to  the  work 
benches  in  such  a  manner  as  to  disperse  as  little  dust  as 
possible  into  the  air  ;  clay  dust  shall  not  be  carried  into  any 
press  shops  in  sacks  except  where  hoppers  or  similar 
receptacles  are  provided  for  receiving  the  clay  dust,  in 
which  case  a  sack  in  sound  repair  shall  be  used  and  the 
mouth  of  the  sack  shall  be  tied  and  only  loosened  after  it 
has  been  placed  in  the  hopper  or  other  receptacle,  which 
shall  be  provided  with  a  cover.  This  clause  shall  also 
apply  to  the  making  from  clay  dust  of  articles  other  than 
tiles,  unless  the  material  is  so  damp  that  no  dust  is  given  off. 

%  (/)  After  one  year  from  the  date  on  which  these 
Regulations  come  into  force,  biscuit  flat  ware  which  has 
been  bedded  for  firing  shall  not  be  removed  from  the 
saggers  after  firing,  except  at  a  bench  fitted  with  an  efficient 
exhaust  appliance  for  the  removal  of  dust. 

%  (g)  Flat-knocking  and  fir ed-flint- sifting  shall  be  carried 
on  only  in  enclosed  receptacles,  which  shall  be  connected 
with  an  efficient  exhaust  draught  unless  so  contrived  as  to 
prevent  effectually  the  escape  of  dust. 

*  (//)  In  the  process  of  ware  cleaning  of  earthenware 
after  the  application  of  glaze  by  dipping  or  other  process, 
wherever  it  is  practicable  to  use  damp  sponges  or  other 


264  LEAD  POISONING 

damp  materials  they  shall  be  provided  in  addition  to  the 
knife  or  other  instrument,  and  shall  be  used. 

*t  (k)  Nothing  in  these  Regulations  shall  render  it 
compulsory  to  provide  an  exhaust  draught  for  ware  clean- 
ing if  this  process  is  carried  on  entirely  with  the  use  of 
wet  materials ;  or  if  the  ware  cleaning  be  done  within 
15  minutes  after  the  moment  when  the  glaze  was  applied  ; 
but  an  efficient  exhaust  draught  shall  always  be  provided  and 
used  if  any  dry  materials  or  implements,  such  as  knives 
or  scrapers,  are  used  after  the  glaze  is  dry  or  more  than 
15  minutes  after  the  moment  when  the  glaze  was  applied. 

*  (/)  In  the  process  of  ware  cleaning,  after  the  applica- 
tion of  glaze  by  dipping  or  other  process,  sufficient  arrange- 
ments shall  be  made  for  any  glaze  scraped  off,  which  is  not 
removed  by  the  exhaust  draught,  to  fall  into  water.  All 
water  troughs  or  other  receptacles  provided  in  pursuance  of 
this  clause  shall  be  cleaned  out  and  supplied  with  fresh 
water  as  often  as  necessary,  and  in  no  case  less  often  than 
once  a  week  ;  and  no  scrapings  of  glaze  shall  be  allowed  to 
collect  in  a  dry  condition  on  the  sides  of  the  water 
receptacle.  Where  grids  or  gratings  are  fitted  over  the 
water  trough  or  other  receptacle  named  in  the  foregoing 
paragraph,  they  shall  be  kept  clean  by  repeated  sponging  or 
wiping  with  wet  material  during  the  time  that  the  process 
of  ware  cleaning  is  being  carried  on.  No  boards  or  other 
articles  shall  be  placed,  even  temporarily,  on  any  such 
water  trough,  in  such  a  way  as  to  interfere  with  the 
efficient  use  of  the  trough . 

(111)  In  all  processes  the  occupier  shall,  as  far  as  practic- 
able, adopt  efficient  measures  for  the  removal  of  dust  and 
for  the  prevention  of  any  injurious  effects  arising  there- 
from. 

(/;)  Every  process  for  which  an  exhaust  draught  is 
prescribed  shall  be  carried  on  inside  a  hood  or  exhaust 
funnel ;  provided  that,  where  the  occupier  can  show  that 
this  is  impracticable,  it  shall  be  sufficient  if  the  work  is 
done  within  the  effective  range  of  an  exhaust  opening. 


FACTORY  AND  WORKSHOP  ORDERS       265 

8.  Respirators. 

(a)  No  person  shall  be  allowed  to  work  without  wearing 
a  suitable  and  efficient  respirator,  such  as  a  damp  sponge 
tied  across  the  mouth  and  nostrils,  in  any  of  the  following 
processes : — 

(i.)  The  emptying  of  sacks  of  plaster  of  Paris  into  a  bin 
in  a  mould-making  shop  ; 
*  (ii.)  The  weighing  out,  and  shovelling,  or  mixing  of 
unfritted  lead  compounds,  in  the  preparation 
or  manufacture  of  frits,  glazes  or  colours  con- 
taining lead,  or  any  process  carried  on  in  a 
room  wherein  any  such  weighing  out,  shovelling, 
or  mixing  has  taken  place  within  the  previous 
thirty  minutes  ; 

unless  an  efficient  exhaust  draught  is  provided  to  prevent 
the  escape  of  dust  into  the  air  of  the  workplace. 

(b)  All  respirators  required  by  this  Regulation  shall  be 
provided  and  maintained  in  a  cleanly  state  by  the  occupier  ; 
and  each  respirator  shall  bear  the  distinguishing  mark  of 
the  worker  to  whom  it  is  supplied. 

9.  Ventilation. 

I  (a)  Every  place  in  which  any  worker  or  workers  are 
employed  shall  be  thoroughly  ventilated. 

I  (b)  All  workrooms  in  which  articles  are  left  to  dry  shall 
be  ventilated  in  such  a  way  as  to  insure  a  continuous 
movement  of  the  air  in  the  room  in  a  direction  away  from 
the  workers  and  towards  the  articles  in  question. 

I  (c)  All  drying  stoves  shall  be  ventilated  direct  to  the 
outside  air  by  shafts  having  upward  inclinations  and  ter- 
minating vertically,  or  by  louvres  in  the  roof,  or  by  other 
effective  means. 

J  (d)  All  mangles  shall  be  so  ventilated  as  to  provide  for 
the  maintenance  of  a  flow  of  air  into  the  hot  chamber 
from  the  adjoining  workroom. 


266  LEAD  POISONING 

In  the  case  of  vertical  or  "  tower"  mangles  : 

(i.)  The  pipes  for  heating  the  mangle  shall  be  fixed 
above  the  top  of  any  opening  at  which  workers 
put  in  or  take  off  wares  ;  and 

(ii.)  There  shall  be  a  free  outlet  into  the  air  above,  so 
formed  and  placed  as  to  insure  an  outflow  what- 
ever the  direction  of  the  wind. 

t  (c)  Fresh  air  shall,  where  practicable,  be  admitted  to 
all  workrooms  by  inlets  placed  along  the  sides  of  the  room 
at  a  height  of  as  nearly  as  possible  6  feet  above  the  floor 
level,  hopper  opening  being  used  for  the  purpose  wherever 
possible. 

1  (/)  Where  it  is  not  practicable  to  provide  such  fresh 
air  inlets,  arrangements  shall  be  made  for  the  entry  of  an 
adequate  amount  of  pure  air  by  a  flue  with  apertures  at 
intervals  along  its  length,  or  other  means,  which  will 
secure  an  even  distribution  of  the  air  through  the  room. 

l  (g)  In  no  case  shall  fresh  air  inlets  be  so  arranged  that 
a  draught  can  blow  direct  from  them  on  to  any  worker. 

1  (//)  Wherever  the  natural  air  currents  are  found  to  be 
insufficient  without  assistance  to  afford  thorough  ventila- 
tion, exhaust  fans  or  other  artificial  means  of  creating  a 
current  of  air  shall  be  provided  and  maintained  in  use. 

J  (k)  Where  an  exhaust  draught  is  provided  for  the  re- 
moval of  dust  generated  in  a  manufacturing  process,  pre- 
cautions shall  be  taken  to  prevent  dust  being  drawn  into 
the  general  atmosphere  of  the  room  from  other  sources  of 
dust  in  places  in  the  vicinity  ;  communication  with  such 
places  shall  be  stopped  wherever  possible,  and  the  fresh 
air  inlets  hereinbefore  mentioned  shall  be  so  arranged  as 
to  insure  that  no  extraneous  dust  is  drawn  towards  the 
workers  by  the  exhaust  draught. 

12.   Floors. 

%  (a)  The  floors  of  all  slip-houses  shall  be  kept  thoroughly 
clean. 

;  (b)  In  all  potters'  shops,  including  such  drying  stoves  as 


FACTORY  AND   WORKSHOP  ORDERS        267 

are  entered  by  workpeople,  and  in  all  places  where  the 
following  processes  are  carried  on,  viz  : — 

*  Making  or  mixing  of  frits,  glazes,  or  colours  contain- 
ing lead, 
*f  Application  of  majolica,  or  other  glaze,  by  blowing, 

painting,  or  any  other  process  except  dipping, 
Preparation,  or  weighing  out,  of  flow  material, 
Ground  laying,  including  the  wiping  off  of  colour  after 

this  process, 
Colour  dusting    f    whether  on-glaze    or    under-glaze, 
Colour  blowing  1        deluding  the  wiping  oft  of  colour 

I        after  either  of  these  processes, 
Colour  grinding  for  colour  blowers, 
Lithographic  transfer  making, 
the  following  Regulations  shall  apply  : — 

(i.)   There  shall  be  provided  and  maintained  : — 

(a)  Either  impervious  floors  ; 

(b)  Or     wooden     floors     with    a    thoroughlv 

smooth  and  sound  surface,  constructed 
in  such  a  substantial  manner  as  to  be 
free  from   permanent   sag,   and   main- 
tained in  such  repair  that  the}-  can  be 
properly  cleaned  bv  a   moist   method, 
and  that  no  dust  can  fall  through  into 
rooms  below, 
(ii.)  The  floors,  when  the  rooms  are  in  use,  shall  be 
thoroughly  cleaned  dailv,  bv  a  moist  method,  by 
an  adult  male  after  work  has  ceased  for  the  day, 
and  before  3  a.m.  next  morning  ;  except  that  in 
rooms  in   which   ground    laying    is   done,   the 
cleaning  prescribed  by  this  Regulation  may  be 
done  before  work  commences  in  the  morning, 
provided   that   in    no    case   shall   any  work   be 
carried  on  in  the  room  within  one  hour  after 
such  cleaning  as  aforesaid  has  ceased. 
(iii.)  Scraps  of   clav   and  other  debris,  including  any 
which  have  collected  under  benches,  shall  not 
be  allowed  to  accumulate  undulv,  and  all  such 


268  LEAD  POISONING 

scraps  and  debris  shall  be  carried  out  at  least 
once  a  day.  Scraps  of  clay  in  potters'  shops  shall 
be  damped  before  being  carried  out. 

In   all   drying   stoves   which   are  entered  by 
workpeople,   boxes  shall   be   provided  for  the 
reception  of  broken  or  waste  clay  ware, 
(iv.)  Suitable  provisions  shall  be  made  forlthe  storage 
of   all   moulds   when    not   in    use.     In   existing 
installations,  the  tops  of  drying  stoves  shall  not 
be  used  for  this  purpose  unless  it  is  shown  to 
the  satisfaction  of  the  Inspector  of  Factories  for 
the    district    that   no    other    suitable    place    is 
available.     In  any  new  erections,  suitable  pro- 
visions shall  be  made  without  utilizing  the  tops 
of  stoves  for  this  purpose,  unless  the  top  of  the 
stove  is  made  into  a  separate  chamber. 
|  (c)  The  floors  of  all  biscuit  placing  and  glost  placing 
shops   shall   be  impervious,  even  floors,  of  brick,  flag  or 
similar  hard  material,  and  shall  be  kept  in  good  repair  ;  they 
shall  be  thoroughly  sprinkled  and  swept  by  an  adult  male 
whenever  the  work  of  setting  in  an  oven  has  ceased,  and 
under  any  circumstances  at  least  once  a  day. 

*t|  {d)  The  floors  of  all  dipping  houses,  dippers'  drying 
rooms,  and  ware  cleaning  rooms  shall  be  washable  im- 
pervious floors,  and  shall  be  thoroughly  cleaned  daily  by  an 
adult  male,  after  work  has  ceased  for  the  day,  with  a 
sufficient  supply  of  water  and  a  mop  or  similar  implement  ; 
provided  that,  in  the  case  of  china  dippers'  drying  rooms, 
this  cleaning  may  be  done  before  work  commences  in  the 
morning,  instead  of  after  work  has  ceased  for  the  day. 

The  floors  of  all  dipping  houses,  dippers'  drying  rooms, 
and  ware  cleaning  rooms  erected  after  the  date  on  which 
these  Regulations  come  into  force,  shall  be  properly  sloped 
towards  a  drain. 

J  (e)  In  any  new  erection  where  steam  pipes  are  used 
for  heating  a  drying  stove,  dippers'  drying  room,  or  any 
place  where  articles  are  left  to  dry,  the  pipes  shall,  if 
possible,  be  fixed  in  the  form  of  a  rack  of  horizontal  pipes 


FACTORY  AND  WORKSHOP  ORDERS       a6g 

in  a  vertical  plane.  Where  this  is  impossible,  the  pipes 
shall  be  fixed  in  such  a  position  as  to  allow  a  thorough 
cleaning  under  and  around  them. 

In  existing  installations,  if  it  is  impracticable  to  comply 
with  the  preceding  paragraph,  the  steam  pipes  shall  be 
enclosed  in  a  box  in  such  a  manner  as  to  permit  of  the 
thorough  cleaning  of  all  parts  of  the  box  on  which  persons 
may  walk  or  stand,  and  adequate  measures  shall  be  taken 
to  prevent  dust  escaping  from  within  the  box.  Slides, 
drawers,  trap-doors  or  other  contrivances  shall  be  pro- 
vided wherever  necessary  to  facilitate  cleaning  under  pipes. 

All  stillages  shall  be  so  arranged  as  to  allow  the  floor  to 
be  thoroughly  cleaned  underneath  them. 

(/)  In  all  workrooms  not  specially  mentioned  in  the  fore- 
going paragraphs  of  this  Regulation,  the  following  Regula- 
tions shall  apply  : — 

All  floors  shall  be  maintained  in  such  repair  that  they 

can  be  properly  cleaned  by  a  moist  method,  and 

shall  be  so  cleaned  daily. 
All  ashes,  dirt  or  other  debris,  including  any  which  have 

accumulated  under  benches,  shall  be  carried  out 

daily. 

(g)  The  above  requirement  as  to  the  daily  cleaning  of 
floors  by  a  moist  method  shall  not  apply  to  places  where 
saggers,  retorts  or  crucibles  are  made,  or  to  those  parts  of 
floors  on  or  immediately  above  which  articles  of  pottery  are 
necessarily  left  overnight,  if  adequate  provision  is  made  for 
the  cleaning  of  the  floors  as  soon  as  the  articles  are 
removed. 

13.    Work  Benches. 

The  following  Regulations  shall  apply  to  work  benches 
in  potters'  shops,  and  in  places  where  processes  named  in 
the  Schedule  are  carried  on  : — 

(*)  %  (a)  Work  benches,  if  not  covered  with  sheet 
metal  or  constructed  with  an  impervious  surface, 
shall   be   strongly   and    solidly    constructed    of 


270  LEAD  POISONING 

closely  jointed  timber,  and  the  surface  of  the 
work  benches  shall  be  well  maintained. 
(*)  |  (b)  All  work  benches  in  use  shall  be  thoroughly 
cleaned  daily  by  a  moist  method. 


14.  Lead  House. 

*  (a)  Raw  lead  .compounds  shall  not  be  handled  except 
with  at  least  5  per  cent,  of  added  moisture. 

*  (b)  They  shall,  further,  be  kept  in  their  original  packages 
until  weighed  out,  and  the  tub  or  other  receptacle  contain- 
ing them  shall  be  so  fitted  either  with  a  cover  or  a  damp 
screen  as  to  prevent  the  issue  of  any  lead  dust  from  its 
mouth. 

*|  (c)  In  every  lead-house,  except  such  as  are  used  for 
less  than  eight  hours  in  any  week,  a  special  lavatory  basin 
with  a  supply  of  hot  and  cold  water,  nail  brush,  soap  and 
towel  shall  be  provided  and  maintained  ;  and  a  solution 
of  soluble  sulphides  shall  be  providedi  in  which  workers  in 
the  lead  house  shall  rinse  their  hands  after  washing  so  as  to 
show  if  they  are  free  from  lead. 

1 5 .  Dipping  House,  etc. 

*t  (a)  In  dipping  houses,  all  parts  of  walls  sufficiently 
near  to  any  dipping  tub  to  be  splashed  with  glaze  shall  be 
tiled,  or  painted  with  washable  paint,  or  otherwise  treated 
in  such  a  manner  as  to  permit  of  thorough  cleaning  by  a 
wet  process. 

*t  .J^b)  The  above-named  parts  of  walls,  as  well  as  the 
dipping  tubs  and  any  other  objects  which  are  splashed 
with  glaze,  shall  be  thoroughly  cleaned  daily  by  a  wet 
process. 

(c)  All  dipping  houses  and  ware  cleaning  rooms  shall  be 
well  lighted  ;  neither  dipping  nor  ware  cleaning  shall  be 
done  in  places  which,  in  ordinary  fine  weather,  are 
dependent  on  borrowed  light  or  artificial  light  during  the 
hours  of  daylight. 


FACTORY  AND  WORKSHOP  ORDERS       271 

1 6.   Threading-up. 

*t|  In  the  process  of  threading-up,  rubber  or  other 
washers,  used  to  keep  articles  apart  when  being  dipped, 
shall  be  thoroughly  washed  in  a  colander  after  each  dipping. 
Wires  shall  also  be  washed  after  each  dipping. 

17.  Boards. 

*  ((7)  Every  board  on  which  dipped  ware  has  been 
placed  shall,  on  each  occasion  after  it  has  been  used  for 
one  set  of  articles  and  before  being  used  for  another,  be 
thoroughly  cleaned  with  clean  water  by  an  adult  male. 

*  (b)  "Nailed"  or  "pegged"  boards  shall  be  cleaned 
under  a  strong  jet  of  water ;  no  new  boards  of  this 
description  shall  be  introduced  except  where  necessary  to 
hold  china  furniture  or  other  special  articles  which  cannot 
be  carried  on  ribbed  or  plain  boards. 

(*)  (I)  (c)  Boards  for  use  in  processes  included  in  Parti, 
of  the  Schedule  shall  be  clearly  marked  by  painting  them 
red  at  the  ends  and  for  a  distance  of  at  least  six  inches 
from  each  end  of  the  board  on  both  sides,  so  as  to  dis- 
tinguish them  from  other  boards  which  do  not  come  into 
contact  with  lead.  Boards  so  marked  shall  not  be  used  in 
any  department  unless  they  have  been  thoroughly  cleaned, 
and  shall  not  be  used  in  the  clay  department  under  any 
circumstances.  Boards  not  so  marked  shall  not  be  taken 
into  any  place  where  a  process  included  in  Part  I.  of  the 
Schedule  is  carried  on  ;  but  this  shall  not  apply  to  placing 
shops  in  which  both  biscuit  and  glost  ware  are  being 
placed,  provided  that  the  boards  used  for  biscuit  ware  are 
kept  separate  and  returned  to  their  respective  departments 
without  any  contact  with  the  boards  used  for  glost  ware. 

18.  Mangles. 

*%  All  mangle  shelves  shall  be  thoroughly  cleaned  by  a 
wet  process  by  an  adult  male  on  a  fixed  day  in  each  week, 
after  work  has  ceased  for  the  day.     The  day  on  which  this 


272  LEAD  POISONING 

cleaning  is  to  take  place  shall  be  fixed  by  entry  in  the 
register  kept  in  pursuance  of  Regulation  3. 

19.   Thimble  Picking. 

(*)  (t)  I  All  material  collected  from  floors  or  work 
benches  shall  be  riddled  in  an  enclosed  receptacle  before  it 
is  taken  to  a  thimble  picking  room. 

20.  Majolica  Painting. 

The  following  Regulations  shall  apply  to  the  process  of 
majolica  painting  : — 

*}  (a)  A  sponge  and  bowl  of.  clean  water,  to  rinse  the 
fingers,  shall  be  'provided  on  the  work  bench 
beside  each  person  employed  in  majolica 
painting. 

*l  (b)  In  all  majolica  painting  shops  where  there  is  no 
adjoining  lavatory  accommodation,  there  shall 
be  provided  in  the  room  a  lavatory  sink  with  a 
tap,  a  constant  supply  of  water,  and  towels. 

*!  (c)  All  splashes  of  glaze  falling  on  the  benches, 
or  surrounding  objects,  shall  be  immediately 
removed  with  a  wet  sponge  or  other  wet 
material. 

*|  (d)  No  floor  or  work  bench  shall  be  deemed  to 
have  been  thoroughly  cleaned,  in  accordance 
with  Regulation  12  or  13,  unless  all  splashes  of 
glaze  have  been  completely  removed. 

*J  (e)  Mottling,  or  any  similar  method  of  applying 
glaze,  shall  only  be  carried  on  under  the  Regu- 
lations applying  to  majolica  painting. 

*+  (/)  All  cleaning  and  scraping,  including  panel- 
cutting,  after  majolica  dipping,  painting,  or 
blowing,  shall  be  deemed  to  be  ware  cleaning, 
and  shall  only  be  done  in  compliance  with  the 
rules  for  the  latter  process. 


FACTORY  AND  WORKSHOP  ORDERS        273 

2 1 .    Cotton-  Wool  in  Ground  Layi?ig,  Colour  Dusting,  and 
Lithographic  Transfer  Making. 

I  All  pieces  of  cotton-wool  or  similar  materials  which 
have  been  used  in  the  process  of  ground  laying,  or  colour 
dusting,  or  lithographic  transfer  making,  shall  be  kept  in  a 
proper  receptacle.  All  pieces  of  waste  cotton-wool  or 
similar  materials  which  have  been  so  used  shall  be 
immediately  burnt. 

22.  Aerographing. 

1  (a)  No  short-sighted  person  shall  be  employed  to 
do  glaze  or  colour  blowing,  unless  wearing  suitable  glasses. 
No  person  shall  be  employed  as  a  glaze  or  colour  blower, 
unless  the  Surgeon  has  entered  in  the  health  register  a  certifi- 
cate stating  that  he  has  examined  the  worker's  sight  and  is 
satisfied  that  he  or  she  can  be  so  employed  without  breach 
of  this  Regulation. 

±  (b)  All  hoods  in  which  the  blowing  of  glaze  or  colour 
is  carried  on  shall  be  thoroughly  cleaned  daily  by  a  wet 
process. 

±  (c)  Glaze  or  colour  blowing  shall  not  be  done  with  the 
mouth. 

%  (d)  Decoration  on  unfired  clay  ware  by  means  of 
coloured  clay  slips  shall  not  be  regarded  as  colour  blowing 
for  the  purposes  of  any  of  the  Regulations  applying  specially 
to  the  latter  process. 

23.  Lithographic  Transfer  Making. 

%  Machines  used  in  lithographic  transfer  making  shall 
not  be  brushed  down,  but  shall  be  cleaned  either — 

(a)  with  moist  materials,  such  as  oily  rags,  in  such  a 

manner  as   not  to   disperse   any  dust  into  the 
air ;  or 

(b)  by  means  of  an  exhaust  current  of  air,  such  as  that 

afforded  by  a  vacuum-cleaner. 


274  LEAD  POISONING 

24.  Separation  of  Processes. 

(*)  (t)  +  (a)  Thimble  picking  or  threading-up  shall  not  be 
carried  on  except  in  a  place  sufficiently  separated  from  any 
process  included  in  the  Schedule. 

(*)  (!)  iP)  When  a  process  included  in  the  Schedule  is 
being  carried  on  in  a  room  where  other  work  is  also  done. 

(i.)  Either  the  place  where  the  scheduled  process  is 
carried  on  shall  be  screened  off  from  the  rest  of 
the  room  by  a  partition  not  less  than  eight  feet 
high, 

(ii.)  Or  all  persons  working  in  the  room  shall  be 
deemed  to  be  persons  employed  in  the  scheduled 
process. 

25.  Hours  of  Employment. 

(a)  No  person  employed  in  a  process  included  in  Part  I. 
of  the  Schedule,  except  in  glost  placing  and  lithographic 
transfer  making,  shall  be  employed  for  more  than  four  hours 
without  an  interval  of  at  least  half  an  hour  for  a  meal. 

No  person  shall  be  employed  in  the  process  of  glost  placing 
or  in  the  process  of  lithographic  transfer  making  for  more 
than  4J  hours,  or  in  any  other  process  for  more  than 
5  hours,  without  an  interval  of  at  least  half  an  hour  for 
a  meal. 

(*)  (+)  (P)  No  woman  or  young  person  who  is  employed 
in  any  process  included  in  Part  I.  of  the  Schedule  shall 
be  employed  in  the  factory  in  any  capacity  for  more  than 
48  hours  in  any  week. 

(*)  (c)  No  adult  male  who  is  employed  as  a  dipper, 
dipper's  assistant,  or  ware  cleaner  shall  be  employed  in  the 
factory  in  any  capacity  for  more  than  48  hours  in  any  week, 
provided  that  where  such  an  adult  male  worker  has  been 
employed  in  a  process  included  in  Part  I.  of  the  Schedule, 
for  not  more  than  8  hours  in  any  one  day  or  30  hours  in  all 
in  a  week,  he  may  be  employed  during  the  same  week 
on  work  not  involving  contact  with  lead  up  to  a  limit  of 
54  hours  for  that  week. 


FACTORY  AND  WORKSHOP  ORDERS        275 

(*)  (d)  No  adult  male  who  is  employed  as  a  glost  placer 
shall  be  employed  in  the  factory  in  any  capacity  for  more 
than  54  hours  in  any  week. 

(*)  [e]  Except  that  it  shall  be  permissible  to  emplo}^ 
adult  male  dippers,  dippers'  assistants,  ware  cleaners,  and 
glost  placers  overtime  in  addition  to  the  prescribed  weekly 
periods  of  48  and  54  hours  ;  provided  that  such  overtime 
shall  not,  in  any  factory  to  which  these  Regulations  apply, 
exceed  4  hours  in  any  week,  or  36  hours  in  any  period  of 
twelve  months.  The  occupier  shall  enter  in  the  prescribed 
register  particulars  of  all  such  overtime,  and  shall  also  send 
notice,  with  the  prescribed  particulars,  to  the  Inspector  of 
Factories  for  the  district,  before  eight  o'clock  in  the  evening 
of  any  day  when  a  man  is  employed  overtime  in  pursuance 
of  this  exception.  An  occupier  who  avails  himself  of  this 
exception  shall,  if  called  upon,  produce  to  the  Inspector  of 
Factories  for  the  district  evidence  of  press  of  orders  or 
other  circumstance  rendering  the  overtime  necessary. 

Adult  male  dippers,  ware  cleaners,  and  glost  placers  may 
be  employed,  in  addition  to  the  above-named  hours,  as 
sitters-up  with  an  oven  after  the  termination  of  the  period 
of  employment  on  one  day  in  the  week  and  before  the 
commencement  of  the  period  of  employment  on  the  next 
day ;  provided  that  no  such  worker  shall  be  employed  in 
any  capacity  within  12  hours  of  the  cessation  of  the  period 
of  sitting-up. 

(/)  In  potters'  shops,  and  in  any  place  where  towing  or 
any  other  dusty  process  is  carried  on,  including  any  process 
for  which  a  certificate  by  an  Inspector  of  Factories  has 
been  given  in  pursuance  of  the  first  paragraph  of  Regula- 
tion 6,  no  women  or  young  person  shall  be  employed  for 
more  than  9^  hours  in  any  day  or  for  more  than  6J  hours  on 
Saturday. 

(g)  All  the  above  weekly  and  daily  periods  shall  be  the 
maximum  permissible  periods  of  actual  work,  exclusive  of 
meal-times. 


276  LEAD  POISONING 

26.  Affixing  of  Regulations. 

(*)  (t)  In  addition  to  the  printed  copies  of  these  Regula- 
tions required  to  be  kept  posted  up  in  pursuance  of  Section 
86  of  the  Factory  and  Workshop  Act,  1901  *  there  shall  be 
kept  constantly  affixed  in  every  potters'  shop  and  in  every 
place  in  which  any  process  included  in  the  Schedule  is 
carried  on,  a  notice  printed  in  bold  type  so  that  it  can  be 
easily  read,  setting  forth  those  portions  of  the  Regulations 
which  apply  to  that  particular  work-place. 

27.  Observance  of  Regulations. 

(a)  A  person  or  persons  shall  be  appointed  who  shall  see 
to  the  observance,  throughout  the  factory,  of  the  Regula- 
tions, and  whose  duty  it  shall  be  to  carry  out  systematic 
inspection  of  the  working  of  all  the  Regulations  in  the 
departments  for  which  they  are  individually  responsible. 
The  names  of  the  persons  so  appointed  shall  be  recorded  in 
the  register. 

(b)  Each  person  so  appointed  shall  be  a  competent 
person  fully  conversant  with  the  meaning  and  application 
of  the  Regulations  in  so  far  as  they  concern  the  depart- 
ments for  which  he  is  responsible.  He  shall  keep  in  the 
factory  a  book  in  which  he  shall  record  any  breach  of  the 
Regulations,  or  any  failure  of  the  apparatus  (fans,  etc.) 
needed  for  carrying  out  the  provisions,  that  he  may  have 
observed,  or  that  may  have  been  brought  to  his  notice 
within  the  preceding  24  hours,  together  with  a  statement 
of  the  steps  then  taken  to  remedy  such  defects  or  to 
prevent  the  recurrence  of  such  breach.  Each  entry  in  such 
book  shall  be  dated  and  initialled  by  the  person  appointed, 
who  at  the  end  of  each  week  shall  make  a  further  entry 
stating  that  the  inspection  required  by  paragraph  (a)  has 
been  carried  out,  and  that  all  the  defects  observed  or 
brought  to  his  notice  have  been  recorded  in  the  book. 
Such  book  shall  be  kept  in  the  factory  for  at  least  six 
months  after  the  latest  entry  therein. 

*  1  Edw.  7,  C.  23. 


FACTORY  AND  WORKSHOP  ORDERS        277 

(c)  Accurate  extracts,  clearly  and  legibly  expressed,  shall 
be  made  of  these  entries  once  a  week,  and  signed  by  the 
occupier  or  someone  whom  he  may  appoint,  and  displayed 
during  the  following  week  in  a  conspicuous  place  in  the 
departments  to  which  they  refer,  and  copies  of  all  such 
extracts  shall  for  the  same  time  be  displayed  in  a  con- 
spicuous place  in  the  mess-rooms. 

28.  Samples  for  Analysis. 

(a)  The  occupier  shall  allow  any  of  His  Majesty's 
Inspectors  of  Factories  to  take  at  any  time  sufficient 
samples  for  analysis  of  any  material  in  use  or  mixed  for  use. 

(b)  Provided  that  the  occupier  may  at  the  time  when  the 
sample  is  taken,  and  on  providing  the  necessary  appliances, 
require  the  Inspector  to  take,  seal,  and  deliver  to  him  a 
duplicate  sample. 

(c)  But  no  analytical  result  shall  be  disclosed  or  published 
in  any  way  except  such  as  shall  be  necessary  to  establish  a 
breach  of  these  Regulations. 

Part  II. — Duties  of  Persons  Employed. 
29.  Periodical  Examinations. 

(*)  (+)  (+)  (a)  All  persons  employed  in  the  processes 
included  in  the  Schedule  shall  present  themselves  at  the 
appointed  times  for  examination  by  the  Surgeon  as  provided 
in  Regulation  2. 

(*)  (+)  (+)  (°)  No  person  after  suspension  shall  work  in  any 
process  in  which  examination  by  the  Surgeon  is  required  by 
these  Regulations  without  a  certificate  of  permission  to  work. 

30.    Overalls,  etc. 

(*)  (1)  {a)  All  persons  employed  in  any  process  included 
in  the  Schedule  shall,  when  at  work,  wear  overalls,  head- 
coverings,  and  aprons,  as  required  by  Regulation  4.  The 
said  overalls,  head-coverings,  and  aprons  shall  not  be  worn 
outside  the  factory  or  workshop,  and  shall  not  be  removed 


278  LEAD  POISONING 

therefrom  except  for  the  purpose  of  being  washed  or 
repaired.  No  overalls,  head-coverings  or  aprons,  provided 
in  pursuance  of  Regulation  4,  shall,  under  any  circumstances, 
be  taken  to  a  worker's  home. 

(*)  (I)  (&)  The  head-coverings  provided  in  accordance 
with  Regulation  4  shall  be  worn  in  such  a  manner  as 
effectually  to  protect  the  hair  from  dust,  and  the  hair  must 
be  so  arranged  as  to  permit  of  this. 

(*)  (+)  (c)  The  overalls,  head-coverings,  and  aprons,  when 
not  being  worn,  and  clothing  put  off  during  working  hours, 
shall  be  deposited  in  the  respective  places  provided  by  the 
occupier  for  such  purposes  under  these  Regulations. 

(d)  Respirators  shall  be  worn  as  required  by  Regulation  8. 

31.  Food. 

(*)  (+)  (a)  No  person  shall  introduce,  keep,  prepare,  or 
partake  of  any  food,  drink,  or  tobacco,  or  remain  during 
meal-times  in  any  place  in  which  is  carried  on  any  process 
included  in  the  Schedule,  or  the  process  of  towing,  or  the 
process  of  tile-making  by  the  compression  of  dust,  or  any 
other  process  which  the  Inspector  of  Factories  for  the 
district  shall  certify  as  sufficiently  dusty  to  render  the  room 
in  which  it  is  carried  on  an  unsuitable  place,  in  his  opinion, 
for  persons  to  remain  during  meal-times. 

(*)  (+)  (b)  Every  worker  for  whom  milk  or  cocoa  is  pro- 
vided in  accordance  with  Regulation  6  shall  drink  the 
same,  unless  a  medical  certificate  is  produced  showing 
cause  for  exemption  from  this  requirement. 

32.    Ventilation — Dust. 

No  person  shall  in  any  way  interfere,  without  the  know- 
ledge and  concurrence  of  the  occupier  or  manager,  with  the 
means  and  appliances  provided  by  the  employers  for 
ventilation,  and  for  the  removal  of  dust. 

33.    Washing. 

(*)  (I)  ia)  No  person  employed  in  any  process  included 
in  the  Schedule  shall  leave  the  works  or  partake  of  meals 


FACTORY  AND   WORKSHOP  ORDERS        279 

without  previously  and  carefully  cleaning  and  washing  his 
or  her  hands. 

(*)  (t)  (b)  No  person  employed  shall  remove  or  damage 
the  washing  basins  or  conveniences  provided  under  these 
Regulations. 

34.  Clea7iing  of  Work  Places. 

The  persons  appointed  by  the  occupiers  shall  clean  the 
several  floors,  walls,  work  benches,  appliances  and  other 
objects  regularly  as  prescribed  in  these  Regulations. 

35.   Boards. 

*  (a)  The  boards  used  in  the  dipping  house,  dippers' 
drying  room,  or  glost  placing  shop  shall  not  be  used  in  any 
other  department,  except  after  being  cleaned,  as  directed  in 
Regulation  17. 

*  (6)  No  board  on  which  dipped  ware  has  been  placed 
shall  be  used  for  a  second  set  of  dipped  articles  until  it  has 
been  thoroughly  cleaned,  in  accordance  with  Regulation  17. 

Where  a  convenient  grid  or  other  suitable  contrivance  is 
provided  for  depositing  such  boards  after  use  and  before 
being  cleaned,  the  worker  who  has  removed  the  ware  from 
any  such  board  shall  place  the  board  thereon. 

(*)  (c)  Boards  which  are  marked  for  use  in  lead  pro- 
cesses shall  not  be  used  in  any  department  unless  they 
have  been  thoroughly  cleaned,  and  shall  not  be  used  in  the 
clay  departments  under  any  circumstances. 

36.  Avoidance  of  Dust,  etc. 

Every  worker  shall  so  conduct  his  or  her  work  as  to 
comply  strictly  with  these  Regulations,  and  to  avoid,  as  far 
as  practicable,  making  or  scattering  dust,  or  refuse,  or 
causing  accumulation  of  such. 

R.  McKenna, 
One  of  His  Majesty's  Principal 
Secretaries  of  State. 
Home  Office,  Whitehall. 
2nd  January,  1913. 


280  LEAD  POISONING 

SCHEDULE. 
Part  I. — Lead  Processes. 

*  (a)  Making  or  mixing  of  frits,  glazes,  or  colours  containing 
lead. 

*  (b)  Dipping  or  other  process  carried  on  in  the  dipping 
house. 

*  (c)  Application  of  majolica,  or  other  glaze,  by  blowing, 
painting,  or  any  other  process  except  dipping. 

*  (d)  Drying  after  the  application  of  glaze  by  dipping,  blow- 
ing, painting,  or  other  process. 

*  (e)  Ware  cleaning  after  the  application  of  glaze  by  dipping, 
blowing,  painting,  or  other  process. 

*  (/)  Placing  of  ware  on  cranks  or  similar  articles  prior  to 
their  transfer  to  saggers  or  kilns  for  the  glost  firing. 

*  (g)  Glost  placing. 

J  (h)  Washing  of  saggers  with  a  wash  which  yields  to  dilute 
hydrochloric  acid  more  than  five  per  cent,  of  its  dry  weight  of 
a  soluble  lead  compound  calculated  as  lead  monoxide  when 
determined  in  the  manner  described  in  the  definition  of  low 
solubility  glaze. 

J  (k)  Preparation,  or  weighing-out,  oiflow  material. 

J  (I)  Ground  laying,  including  the  wiping  off  of  colour  after 

this  process. 

.    .  _  ,         ,     ,.        (whether    on  -  glaze    or   under  -  glaze, 
hi)  Colour  dusting   \      .     ,    ,.        .,°  „     r    ° 

including  the  wiping  off  of  colour 


%  («)   Colour  blowing  (      after  either  of  these  processes# 

J  (o)  Colour  grinding  for  colour  blowers. 

t  (p)  Lithographic  transfer  making. 

J  (q)  Any  other  process  in  which  materials  containing  lead 
are  used  or  handled  in  the  dry  state,  or  in  the  form  of  spray,  or 
in  suspension  in  liquid  other  than  oil  or  similar  medium,  pro- 
vided that  the  stopping  of  biscuit  ware  with  a  material  containing 
lead  shall  not  be  deemed  to  be  a  process  included  in  this 
Schedule. 

Part  II. — Other  Processes. 

X  (r)  Scouring  of  biscuit  ware  which  has  been  fired  in 
powdered  flint. 

I  (s)  Emptying  of  biscuit  ware  which  has  been  fired  in 
powdered  flint,  from  the  baskets  or  other  receptacles  in  which 
it  has  been  conveyed  to  the  biscuit  warehouse  or  scouring  shop. 


FACTORY  AND    WORKSHOP  ORDERS        281 

APPENDIX. 

Codes    of    Special    Rules    established    uxder    the 
Factory  and  Workshop  Acts,  1891  and  1895. 

1.  For  the  Manufacture  of  White  Lead. 

In  these  Rules  "  persons  employed  in  lead  process " 
means  a  person  who  is  employed  in  any  work  or  process 
involving  exposure  to  white  lead,  or  to  lead  or  lead  com- 
pounds used  in  its  manufacture,  or  who  is  admitted  to  any 
room  or  part  of  the  factor}-  where  such  process  is  carried  on. 

Any  approval  given  by  the  Chief  Inspector  of  Factories 
in  pursuance  of  Rules  2,  4,  6,  9,  or  12  shall  be  given  in 
writing,  and  may  at  any  time  be  revoked  by  notice  in 
writing  signed  by  him. 

Duties  oj  Occupiers. 

1.  On  and  after  July  1st,  1899,  no  part  of  a  white  lead 
factory  shall  be  constructed,  structurally  altered,  or  newly 
used,  for  any  process  in  which  white  lead  is  manufactured 
or  prepared  for  sale,  unless  the  plans  have  previously  been 
submitted  to  and  approved  in  writing  by  the  Chief  Inspector 
of  Factories. 

2.  (a)  Every  stack  shall  be  provided  with  a  standpipe 
and  movable  hose,  and  an  adequate  supply  of  water  dis- 
tributed by  a  rose. 

(b)  Every  white  bed  shall,  on  the  removal  of  the  covering 
boards,  be  effectually  damped  by  the  means  mentioned 
above. 

Where  it  is  shown  to  the  satisfaction  of  the  Chief  In- 
spector of  Factories  that  there  is  no  available  public  water 
service  in  the  district,  it  shah  be  a  sufficient  compliance 
with  this  Rule  if  each  white  bed  is,  on  the  removal  of  the 
covering  boards,  effectually  damped  by  means  of  a  watering 
can. 

3.  Where  white  lead  is  made  by  the  chamber  process, 
the  chamber  shall  be  kept  moist  while  the  process  is  in 
operation,  and  the  corrosions  shall  be  effectually  moistened 
before  the  chamber  is  emptied. 


282  LEAD  POISONING 

4.  (a)  Corrosions  shall  not  be  carried  except  in  trays  of 
impervious  material. 

(b)  No  person  shall  be  allowed  to  carry  on  his  head  or 
shoulder  a  tray  of  corrosions  which  has  been  allowed  to 
rest  directly  upon  the  corrosions,  or  upon  any  surface 
where  there  is  white  lead. 

(c)*  All  corrosions  before  being  put  into  the  rollers  or 
washbecks,  shall  be  effectually  damped,  either  by  dipping 
the  tray  containing  them  in  a  trough  of  water  or  by  some 
other  method  approved  by  the  Chief  Inspector  of  Factories. 

5.  The  flooring  round  the  rollers  shall  either  be  of  smooth 
cement  or  be  covered  with  sheet  lead,  and  shall  be  kept 
constantly  moist. 

6.  On  and  after  January  1st,  1901,  except  as  hereinafter 
provided — 

(a)  Every  stove  shall  have  a  window,  or  windows,  with 

a  total  area  of  not  less  than  8  square  feet,  made 
to  open,  and  so  placed  as  to  admit  of  effectual 
through  ventilation. 

(b)  In  no  stove  shall  bowls  be  placed  on  a  rack  which 

is  more  than  10  feet  from  the  floor. 

(c)  Each  bowl  shall  rest  upon  the  rack,  and  not  upon 

another  bowl. 
{d)  No   stove   shall   be   entered   for    the    purpose   of 
drawing   until  the  temperature  at   a  height  of 
5  feet  from  the  floor  has  fallen  either  to  700  F., 
or  to  a  point  not  more  than  io°  F.  above  the 
temperature  of  the  air  outside. 
(e)  In  drawing  any  stove  or  part  of  a  stove  there  shall 
not  be  more  than  one  stage  or  standing  place 
above  the  level  of  the  floor. 
Provided  that  if   the  Chief  Inspector  approves  of  any 
other  means  of  ventilating  a  stove,  as  allowing  of  effectual 

*  The  following  addition  to  Rule  4  (c)  is  in  force  in  one  works  : — 
"  Provided  that  the  damping  of  the  corrosions  shall  not 
be  required  if  efficient  exhaust  ventilation  is  applied 
at  the  washbecks  in  such  manner  as  to  prevent  the 
inhalation  of  dust  by  the  workers  when  putting  the 
corrosions  into  the  washbecks  or  rollers." 


FACTORY  AND  WORKSHOP  ORDERS        283 

through  ventilation,  such  means  may  be  adopted,  notwith- 
standing paragraph  (a)  of  this  rule  ;  and  if  he  approves  of 
any  other  method  of  setting  and  drawing  the  stoves,  as 
effectually  preventing  white  lead  from  falling  upon  any 
worker,  such  method  may  be  followed,  notwithstanding 
paragraphs  (b)  and  (e)  of  this  Rule. 

7.  No  person  shall  be  employed  in  drawing  Dutch  stoves 
on  more  than  two  days  in  any  week. 

8.  No  dry  white  lead  shall  be  deposited  in  any  place  that 
is  not  provided  either  with  a  cover  or  with  a  fan  effectually 
removing  the  dust  from  the  worker. 

9.  On  and  after  January  1st,  1900,  the  packing  of  dry 
white  lead  shall  be  done  only  under  conditions  which 
secure  the  effectual  removal  of  dust,  either  by  exhaust  fans 
or  by  other  efficient  means  approved  in  each  case  by  the 
Chief  Inspector  of  Factories. 

This  rule  shall  not  apply  where  the  packing  is  effected 
by  mechanical  means  entirely  closed  in. 

10.  The  floor  of  any  place  where  packing  of  dry  white  lead 
is  carried  on  shall  be  of  cement,  or  of  stone  set  in  cement. 

11.  No  woman  shall  be  employed  or  allowed  in  the  white 
beds,  rollers,  washbecks,  or  stoves,  or  in  any  place  where 
dry  white  lead  is  packed,  or  in  other  work  exposing  her  to 
white  lead  dust. 

12.  {a)  A  duly  qualified  medical  practitioner  (in  these 
Rules  referred  to  as  the  "  Appointed  Surgeon  ")  shall  be 
appointed  by  the  occupier  for  each  factory,  such  appoint- 
ment to  be  subject  to  the  approval  of  the  Chief  Inspector. 

(b)  No  person  shall  be  employed  in  a  lead  process  for 
more  than  a  week  without  a  certificate  of  fitness  granted 
after  examination  by  the  Appointed  Surgeon. 

(c)*  Every  person  employed  in  a  lead  process  shall  be 

*  The  following  Rule  is  in  force  in  one  works  in  substitution 
for  Rule  12  (c)  : — 

"  Every  person  employed  in  a  lead  process  shall  once  in 
each  calendar  month,  on  a  date  of  which  notice  shall 
be  given  to  every  person,  be  examined  by  the 
Appointed  Surgeon,  who  shall  have  power  to  suspend 
from  employment  in  any  lead  process." 


284  LEAD  POISONING 

examined  once  a  week  by  the  Appointed  Surgeon,  who 
shall  have  power  to  order  suspension  from  employment  in 
any  place  or  process. 

(d)  No  person  after  such  suspension  shall  be  employed 
in  a  lead  process  without  the  written  sanction  of  the 
Appointed  Surgeon. 

(e)  A  Register  in  a  form  approved  by  the  Chief  Inspector 
of  Factories  shall  be  kept,  and  shall  contain  a  list  of  all 
persons  employed  in  lead  processes.  The  Appointed  Sur- 
geon will  enter  in  the  Register  the  dates  and  results  of  his 
examinations  of  the  persons  employed,  and  particulars  of 
any  directions  given  by  him.  The  Register  shall  be  pro- 
duced at  any  time  when  required  by  H.M.  Inspectors  of 
Factories  or  by  the  Certifying  Surgeon  or  by  the  Appointed 
Surgeon. 

13.  Upon  any  person  employed  in  a  lead  process  com- 
plaining of  being  unwell,  the  occupier  shall,  with  the  least 
possible  delay,  give  an  order  upon  a  duly  qualified  medical 
practitioner. 

14.  The  occupier  shall  provide  and  maintain  sufficient 
and  suitable  respirators,  overalls,  and  head-coverings,  and 
shall  cause  them  to  be  worn  as  directed  in  Rule  29. 

At  the  end  of  every  day's  work  they  shall  be  collected 
and  kept  in  proper  custody  in  a  suitable  place  set  apart  for 
the  purpose. 

They  shall  be  thoroughly  washed  or  renewed  every  week  ; 
and  those  which  have  been  used  in  the  stoves,  and  all 
respirators,  shall  be  washed  or  renewed  daily. 

15.  The  occupier  shall  provide  and  maintain  a  dining- 
room  and  a  cloak-room  in  which  workers  can  deposit 
clothing  put  off  during  working  hours. 

16.  No  person  employed  in  a  lead  process  shall  be  allowed 
to  prepare  or  partake  of  any  food  or  drink  except  in  the 
dining-room  or  kitchen. 

17.  A  supply  of  a  suitable  sanitary  drink,  to  be  approved 
by  the  Appointed  Surgeon,  shall  be  kept  for  the  use  of  the 
workers. 

18.  The  occupier  shall  provide  and  maintain  a  lavatory 


FACTORY  AND   WORKSHOP  ORDERS        285 

for  the  use  of  the  workers,  with  soap,  nail  brushes,  and  at 
least  one  lavatory  basin  for  every  five  persons  employed. 
Each  such  basin  shall  be  fitted  with  a  waste  pipe.  There 
shall  be  a  constant  supply  of  hot  and  cold  water  laid  on, 
except  where  there  is  no  available  public  water  service,  in 
which  case  the  provision  of  hot  and  cold  water  shall  be 
such  as  shall  satisfy  the  Inspector  in  charge  of  the 
district.* 

The  lavatory  shall  be  thoroughly  cleaned  and  supplied 
with  clean  towels  after  every  meal. 

There  shall,  in  addition,  be  means  of  washing  in  close 
proximity  to  the  workers  of  each  department,  if  required 
by  notice  in  writing  from  the  Inspector  in  charge  of  the 
district. 

There  shall  be  facilities,  to  the  satisfaction  of  the  Inspector 
in  charge  of  the  district,  for  the  workers  to  wash  out  their 
mouths. 

19.  Before  each  meal,  and  before  the  end  of  the  day's 
work,  at  least  ten  minutes  in  addition  to  the  regular  meal 
times,  shall  be  allowed  to  each  worker  for  washing. 

A  notice  to  this  effect  shall  be  affixed  in  each  depart- 
ment. 

*  The  following  Rule  is  in  force  in  certain  works  in  substitu- 
tion for  paragraph  1  of  Rule  iS  :  — 

"The  occupier  shall  provide  and  maintain  in  a  cleanly 
state  and  in  good  repair  for  the  use  of  persons  em- 
ployed a  lavatory  containing  either — 

' '  (a)  At  least  one  lavatory  basin  for  every  five  such 
persons,  fitted  with  a  waste  pipe,  or  placed 
in  a  trough  having  a  waste  pipe,  and  having 
a  constant  supply  of  hot  and  cold  water, 
or  warm  water,  laid  on  ;  or 
"  (6)  Troughs  of  enamel   or   similar  smooth    im- 
pervious material,  fitted  with  waste  pipes 
without  plugs,  and  having  a  constant  supply 
of  hot  and  cold  water,  or  warm  water,  laid 
on.     The  length  of  such  troughs  shall  be 
in  a  proportion  of  not  less  than  2  feet  for 
every  five  persons  employed. 
"  He   shall    also    provide   in   the    lavatory,    soap,    nail 
brushes,  and  a  sufficient  supply  of  towels." 


286  LEAD  POISONING 

20.*  The  occupier  shall  provide  and  maintain  sufficient 
baths  and  dressing  rooms  for  all  persons  employed  in  lead 
processes,  with  hot  and  cold  water,  soap,  and  towels,  and 
shall  cause  each  such  person  to  take  a  bath  once  a  week  at 
the  factory. 

A  bath  register  shall  be  kept,  containing  a  list  of  all 
persons  employed  in  lead  processes,  and  an  entry  of  the 
date  when  each  person  takes  a  bath. 

This  register  shall  be  produced  at  any  time  when  re- 
required  by  H.M.  Inspectors  of  Factories  or  by  the  Certi- 
fying Surgeon  or  by  the  Appointed  Surgeon. 

21.  The  dressing-rooms,  baths,  and  w.c.'s  shall  be  cleaned 
daily. 

22.  The  floor  of  each  workroom  shall  be  cleaned  daily, 
after  being  thoroughly  damped. 


Duties  of  Persons  Employed. 

23.  No  person  shall  strip  a  white  bed  or  empty  a  chamber 
without  previously  effectually  damping  as  directed  in 
Rules  2  and  3. 

24.  No  persons  shall  carry  corrosions,  or  put  them  into 
the  rollers  or  washbecks,  otherwise  than  as  permitted  by 
Rule  4. 

25.  No  person  shall  set  or  draw  a  stove  otherwise  than 
as  permitted  by  Rules  6  and  7. 

26.  No  person  shall  deposit  or  pack  dry  white  lead  other- 
wise than  as  permitted  by  Rules  8  and  9. 

27.  Every  person  employed  in  a  lead  process  shall  present 
himself  at  the  appointed  times  for  examination  by  the 
Appointed  Surgeon,  as  provided  in  Rule  12. 

*  The  following  proviso  to  Rule  20  is  in  force  in  one  works  : — 
"  Provided  that  this  Rule  shall  not  apply  if  the  Chief 
Inspector  of  Factories  approves  the  use  of  the  local 
public  baths  when  conveniently  near,  under  the  con- 
ditions (if  any)  named  in  such  approval," 


FACTORY  AND  WORKSHOP  ORDERS        287 

The  following  marks  used  in  the  Health  Register  of 
Lead  Factories  are  those  recommended  by  the  Home 
Office  to  Certifying  Factory  Surgeons  and  to  medical  men 
appointed  to  lead  works  : 

-  means  worker  passed  without  comment. 
a 

,,      a  blue  line  on  the  gums,  or  an  indication  thereof. 

a  ° 

be  ,,  increasing  impairment  of  general  health. 

c  ,,  pregnancy  without  suspension. 

d  ,,  suspension  or  transfer  for  reasons  other  than  lead. 

x  ,,  carelessness  or  unsuitability  for  lead  work. 

dx  „  suspension  for  such  reasons. 

1 

7      ,,      anaemia. 

b 


INDEX 


Abductor  muscles,  affected, 
150 

Abortion,  8,  92,  153 

Acute  lead  poisoning,  140.  See 
Saturnine  encephalopathy 

Aerographing,  Home  Office  reg- 
ulations, 273 

Albumin  in  spinal  fluid,  158 

Albuminuria,  141,  174,  191,  21 1, 
212 

Alcoholism  predisposes  to  plum- 
bism,  99,  162 

Aldehyde  in  lead  paints,  40,  41, 

45 

Alimentary  canal,  117,  166 

Amaurosis  and  amblyopia,  113, 
144.     See  Blindness 

Anaemia,    77,     129,     132,     191, 
197,  209,  211 
pernicious,  126 

Anaesthesia,  154 

Analgesia,  154 

Aniline  poisoning  and  basophi- 
lia, 125 

Antiseptic  properties  of  paints, 

64 

Appendicitis,  lead  poisoning  mis- 
taken for,  139 

Arteries,  changes  in,  and  arterio 
sclerosis,  97,  103,  191 

Barium  sulphate  a  substitute  for 

lead,  57,  61 
Basic  sulphate  of  lead,  41 
Basophilia,   20,   112,    123,   157, 

197 


Baths,  electric,  212,222 
in  factories,  203,  209 
weekly,  required  by  Home 
Office,  224,  286 
Benzine,  49 
Benzole,  51 

Bladder  affected  in  lead  poison- 
ing, 48,  153 
Blend  ore,  17 

Blindness,  76,  118,  144,  154 
Blood-films,  method  of  staining, 

131 

Blood,  basophile  red  corpuscles, 
130,  159,  169 
eosinophils,  132 
in  saturnine  poisoning,  20, 
48,    123,    127,  159,   161, 
169 
pressure,  185,  188,  205 
red   corpuscles,    disintegra- 
tion of,  51 
reduction  of,  122 
white  corpuscles,  132 
"  Blue  bed,"  23,  176 
Boro-silicate,    90.     See    "Grit- 
ted "  lead 
Brain,  119,    142,  145,  156,  187, 
189,  194 
haemorrhages  in  cortex  of, 

119,  146 
vessels  of,  189 
Broken  Hill  Mines,  lead  fumes 

at,  7 
Bronchial  affections,  prevalence 

of,  among  lead  miners,  3 
Bulbar  paralysis  in  cats,  168 


INDEX 


289 


Bulbar  paralysis,  rare  in  man, 

112,   171 

Burdach's  column,  112,  169 
Burtonian  line    on    gums,    133, 
197.     See  Gums 

Cachexia-1  128,  194,  202 

Calamine  ore,  17 
Canned  foods  and  lead  poison- 
ing, 92 
Carbon  dioxide,  45,  47 

monoxide,  12,  45,  67 
Cases  of  lead  poisoning,  histories 

and  tables,  1 18 
Casual  labour  in  lead  factories, 

102,  162 

Cats,  lead  poisoning  in,  1  to,  112 

Cattle  poisoned  by  lead  fume,  5 

symptoms  of  lead  poisoning 

in,  9 

Central  nervous  system  affected, 

147 

Cerebellum,  120 

Cerebral  haemorrhage,  97,  146, 
192 
tumour,  191 

Cerebro-spinal  fluid,  157,  159 

Cerussa,  31 

Cerussite,  4 

"Chamber"  process  in  manu- 
facture of  white  lead,  23,  29, 

3.2 

China  and  earthenware,  manu- 
facture of,  68 

Cirrhosis  of  liver,  172 

Coal    gas,    action    of,    on    zinc 
white,  58 

Colic,  20,    136,  140,   144,    164. 
194,  197,  209 

Compositors,  124.    See  Printers 

Constipation,  68.  99,  114,  136, 
140,  171,  210 

Convulsions,  20,  118,  136,  141, 
146,  175,  178,  211 
in  infancy,  178 

Cosmetics,    lead   poisoning   due 
to,  113 

Cupelling,  19 


Delirium    and    delusions,    141, 

155 
Diachylon,   92,    103,    130,    139, 

147.  153 
Diamond  cutting,  91 
Diarrhoea,  140 
Diplopia,  153 
"Dipping''  of  earthenware,  71, 

Distilled   water   and   its   action 

upon  lead,  93 
Dogs  and  lead  poisoning,  no 
Drinking  water,  lead  in,  44,  92, 
165,  193 
from  peaty  soil,  92 
"  Dryers "  in  paints,  41 
benzole,  47 
turpentine,  47 
white  lead,  59 
Drying-ovens,   air   of,  in  white 

lead  factory,  167 
Dust.     See  Lead  dust 
"Dutch"   process  in  manufac- 
ture of  white  lead,  23,  29,  32 
Dyeing  of  yarn  by  chromate  of 
lead,  89,  241 

Electrical  accumulators,  82,  163, 
164 
manufacture  of,  Home 
Office  orders,  227 
treatment     for     plumbism, 
211,  222 
Elimination    of    lead     by    the 
faeces,  161 
by  the  urine,  169,  170 
Emanations  from  newly  painted 
room,  39 
benzine,  50 
petroleum  spirit,  49 
turpentine,  48 
Enamelling,  90 
Encephalopathy,  20 
Eosinophiles,  132 
Epileptic  seizures,  20,  146 
Erythrocytes,  punctated,  20, 123, 

127 
Exhausts,  2o8;  264 

19 


290 


LEAD  POISONING 


J 


Eye: 

disc,  alterations  of,  144,  154 
fundus  oculi,  143 

small  haemorrhages  in 
fundus,  154 
inflammation  of,  48 
paralysis    of    muscle,    133, 

154 
pupils,  unequal,  153 
retinal  hemorrhages,  153 

Factory  and  Workshop  Orders, 

225 
Faeces,  lead  eliminated  by,  107, 

117,  161 
Female  labour,  abolition  of,  in 

dangerous   processes,    by  the 

Home  Office,  98,  176,  203 
File-cutting,  80 

and  pulmonary  tuberculosis, 

85 
Home  Office  Orders,  225 
File-cutters,     high      mortality 

among,  81 
"  Flinting,"  252 
Flue-dust,  13 

Flues,  cleaning  out  of,  14,  206 
Food  not  to  be  taken  into  lead 
works,  203 
Home  Office  Orders,  258 
Formic  acid,  45,  47 
"Fritted  "  lead,  71,  90 
Fume,    5,    7,   13,    16,   97,   166, 
204 

Galena,  4,  12,  249 

Gastric  juice,    action    on   lead, 
105 

General  paralysis,  156,  194 

Gingivitis,  132 

Glass  works,  lead  poisoning  in, 
89 

Glaze,  high  percentage  of  lead 
in,  69 
leadless,  249 

"  Glost  placing,"  252 

Goll's  column,  cellular  infiltra- 
tion in,  112,  169 


Goulstonian    Lectures,    Oliver, 

99,  ii7 
Gout,  200 
Guinea-pigs,  lead  poisoning  in, 

46 
Gums,  blue  line  on,  12,  77,  90, 
97,    100,  103,    117,   128, 
131,  154,  194,  197 
inflamed  in  benzine  poison- 
ing, 51 
ulcerated,  134 

Haematoporphyrin  in  urine,  175 
Haemoglobin,  122,  129 
Haemorrhages  in  brain,  97,  119, 
146,  149 
in  fundus,  143,  154 
in  intestine,  175 
in  mucous  membranes,  51 
Hair-dyes  containing  lead,  113 
Hallucinations,  50 
Hat-pins,  glass-topped,  90 
Headache,  114,  141,  154,  292 
Heart,  effect  of  lead  upon,  119, 

185,  189 
Home    Office,    plans    for   new 
factories     submitted     to, 
207 
reforms   introduced   by,  in 

the  Potteries,  69,  72 
Regulations,  98,   140,  176, 

203,  225 
Reports,  17,  34,  35,  66,  69, 

73 
Hours  of  employment  in  pot- 
teries, 274 
Hungarian  potters,  79 
Hydrochloric  acid,  166,  192 
in  the  gastric  juice,  action 
of,  on  lead,  105 
Hygiene,  personal,  among  lead 

workers,  203 
Hyperesthesia  in  peroneal  type 

of  lead  paralysis,  152 
Hyperalbuminosis,  157 
Hysteria,  saturnine,  142,  194 

Imbecile  children,  76 


INDEX 


291 


Industrial  lead  poisoning,  statis- 
tics, 34 
Inequality  of  the  pupils,  138 
Infancy,  deaths  in,  77,  178,  199 
Insanity,  following  lead  poison- 
ing, 20,  155 
Interstitial  nephritis,  173,  211 
Intestinal    mucous    membrane, 

action  of  lead  on,  106 
Intestine,  120 

bluish- black     patches    on, 

171 
haemorrhages  in.  175 
Iron  sulphide,  62 

Kidneys,  49,  68,  97,   103,   139, 

145,  171,  191,  200,  212 
Knee-jerk,  156 

Lace  workers,  plumbism  among, 

on  the  Continent,  91 
Lamina  cribrosa,  146 
Larynx,    muscles    of,    affected, 

153 
Lead,  acetate  of,  31,  114 
albuminate,  134,  17 1 
carbonate.    See  "White  lead 
channels   of  entrance   into 
body,  alimentary,  respira- 
tory, 115,  117 
chloride,  97,  105 
chromate,  98 
dust,  71,  97,  116 
from  slag,  12 
suppression   of,    in   in- 
dustrial occupations, 
36,  204,  260 
elimination  of,  by  feces  and 

urine,  107,  108 
factories,        preventive 

methods  in,  205 
glazes,    a    standard    of    in- 
solubility for,  72 
hydroxide,  41 
miners    and    lead    poison- 

.  ing,  4 

liable     to     pulmonary 
tuberculosis,  3 


Lead   miners  liable  to  rheuma- 
tism, 3 
mines  not  ventilated,  3 
nitrate,  98,  186 
oleate,  154 
oxide,  41,  97 
paints  and  leadless  paints, 

55 

paralysis,     types    of,     15 1. 
See  also  Paralysis 
in  children,  152 
pipes    and    drinking-water. 

93  . 
poisoning,  causes  of.  92 

chronic,  38,    155,   159, 

173.  199 

effects  on  offspring  of, 

183 
what  constitutes,  196 
red.     See  Red  lead 
small    quantities    harmful. 

166 
sulphate,    23,    40,   63,    98, 

108 
sulphide,  133,  171 
white.     See  White  lead 
respiratory  organs,  115 
skin,  113 
"  Leadless  glaze,"  249 
';  Lead  process,"  233 
Leucocytosis,  132,  157 
Linseed  oil,  27,  40,  44,  47,  59, 

206 
Litharge,  18 

flaked,      manufacture      of, 
Home  Office  Order,  241 
Lithopone.  57,  61 
Liver,  65,  117,  120,  171 
cells,  atrophy  of,  172 

Majolica  painting,  75,  250,  272 
Manganese  binoxide,  41 
Mania,  acute,  in  lead  poisoning, 

141 
Memory,  affected,  30 
Metabolism,  162 
Minium,  4 
Miscarriages,  8,  96,  178.  194 


292 


LEAD  POISONING 


Muscles,  abductor,  150 

anti-brachial,  151 

biceps,  151 

brachialis  anticus,  151 

deltoid,  151 

groups       affected,      Aran- 
Duchenne,  151 
Dejerine-Klumpke,  151 
Duchenne-Erb,  151 

extensor,  13,  150 

of  eyeballs  paralyzed,  153 

of  leg  affected,  152 

psoas,  152 

supinator  longus,  150 

supra-    and    infra-scapular, 

effect  of  lead  on,  185 
Muscular  atrophy,  157 

Nephritis,  173,  200,  211 

Nerve  cells  in  visual  centres  of 

brain,  144 
Nervous  system,  147 
Neuro-retinitis,  143,  154 
Nitrobenzene  poisoning,  125 
Notification  of  plumbism  volun- 
tary in  Great  Britain,  65 

CEdema  of  the  feet,  211 
Ophthalmoscopic  changes,  143 
Optic  nerve,  145 
Ore,  4 

Pain,  154 

Painted     surfaces,     emanations 

from,  39,  55 
Painters,  38,  39,  65 
Paints,   manufacture  of,   Home 

Office  Orders,  232 
Paralysis,   66,    111,    130,     147, 
152,  163,  168,  178,  182 
among  painters,  66,  68 
among  pottery  workers.  69, 

76 
of  hands  and  arms,  12,  21, 

152,  182,  199 
of  muscles  of  eye,  133,  144 
respiratory,  153 


Peaty    soils,    water    from,    93, 

209 
Petroleum  spirit,   vapour  from, 

49 

Phagocytic  cells  of  gum,  134 
Plumbers   and   lead   poisoning. 
88 
l    Plumbism.     See  Lead  poisoning 
I    Potassium  iodide,  114,  134, 171, 
210 
Potters  and  lead  poisoning,  70 
and    pulmonary   tuberculo- 
sis, 85 
Hungarian,  76 
Pottery,  manufacture  of,  68 

and      decoration      of, 
Home  Office  Orders, 
248 
Pregnancy,  lead  poisoning  and, 

178 
Premature  births  caused  by  lead 

poisoning,  8,  178 
Presaturnism,  period  of,  103 
Printers,  lead  poisoning  among, 
83,86 
tuberculosis  among,  83,  87 
Printing  and  type  founding,  83 

of  colours  on  calico,  89 
Pseudo-general    paralysis,    156, 

160 
Ptosis,  153 
Putty,  89 

Rabbits,  lead  poisoning  in,  11 1 
Red  blood  corpuscles,  123.    See 

also  Blood 
Red  lead,   18,  6o,  82,  88,  116, 
140,  205 
Home  Office  Orders  regard- 
ing manufacture,  241 
Respiration  not  directly  affected 

by  lead,  188 
Respirators,  101,  206,  208,  265 
Respiratory  organs,  115 

paralysis,  153 
Retina,  alterations  of,  144 
Rheumatism,  lead  miners  liable 
to,  3 


INDEX 


293 


Salivary  giands,  175 
Sand-papering  painted  surfaces, 

39)  S2 
Saturnine   encephalopathy,    76, 
102,  140,  142,  201 
nephritis,  200 
pseudo-general       paralysis, 

156 

"Scouring"     of     earthenware, 

252 
Sensory  symptoms,  154 
Silicosis,  3 
Skin,  entrance  of  lead  by,  113 

inflammation  of,  48 
Slag,  n 
Smelting,  5 

Home  Office  Orders,  241 

methods  of,  11 

Parkes'  process,  16 

Pattison  process,  16 
Spasm  of  bloodvessels  of  brain, 
142,  144 

of    small    arteries   of    eye, 

.  x44 
Spastic  paralysis,  168 

paraplegia,  11 1 
Spelter,  17 

Sphygmogram,  1 90,  205 
Sputum,  cerussite  in,  4 
Squint,  114 

Stereotyping  machines,  167 
Stillbirths,  178,  194 
Sulphide   of  soda,   tabloids  of, 

given  to  workmen,  207 
Sulphocyanide  of  potassium  in 

saliva,  134 
Sulphur,  114,  157 

baths,  treatment  by,  157 
Sulphuretted   hydrogen,    action 

of,  upon  painted  surfaces,  58, 

133 

Symptomatology,  102,  122 
Syphilis,  156 

Teeth,  decayed,  effect  of,  134 
Tinning  of  hollow  ware,  90 
Tobacco,  use  of,  harmful  when 
at  work,  100,  203 


Toxic  products,  foimation  of,  in 

the  system,  161 
Treatment,  curative,  209 

preventive,  201 
Tremors,    fibrillary,    of    hand, 

152 
important  sign  of  plumbism, 

154 
Tuberculosis,  pulmonary,  among 
file-cutters,  85 
among  miners,  3 
among  potters,  85 
among  printers,  83,  85 
Turpentine,  41,  42,  43,  48,  67 

Underground  flue,  5 
Unilateral  tenderness  and  sweat- 
ing, 138 
Uraemia,  139 

Urine,    albumin   in,    141,    191, 
212 
chemical    examination    of, 

192 
hsematoporphyrin  in,  175 
lead   present   in,    92,    129, 

132,  143,  169,  195,  197 
lead  thrown  out  of  body  by, 
169, 170 

Ventilation,  207 

Home    Office    Regulations 
for,  265 
Vision,  loss  of,  143 
Vulcanization,  62 

Wassermann  reaction,  157 
Water  poisoned  by  lead  fume,  7 

See  Drinking  water 
"Weight,  loss  of,  in  lead  poison- 
ing, 122 
"White"  bed,  25,  98 
White  lead,  4,  22,  41,  57,  71, 
98,  108,  116,  205 
Home    Office    Orders    re- 
garding  manufacture   of 
281 
legislation    in    France    re- 
garding, 29 


294 


LEAD  POISONING 


White  lead,  manufacture  of,  22 

use  of,  by  plumbers,  89 
Women  and  lead  poisoning,  8, 
74,  98,  176 
employed    in    making    up 
"  blue-beds,"  24 
Workmen's  Compensation  Act, 

196 
Wrist-drop,    49,   91,    113,    134. 
147,  151,  154,  197,211 


Yarn,  dyeing  of,  with  lead  com- 
pound, 237 

Zinc,  16,  17 

chloride,  17 
fumes,  18 
oxide,  17,  57,  59 
sulphate,  61 
sulphide,  17,  57,  61 
white,  41,  54,  57,  61 


H.  K.  LEWIS,  136,  GOWER  STREET,  LONDON 


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Lead  poisoning. 


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COLUMBIA  UNIVERSITY  LIBRARIES 


0037546350 


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